Twenty-Year Time Trends in Long-Term Case-Fatality and Recurrence Rates After Ischemic Stroke Stratified by Etiology

Area of Science:

• Neurology
• Epidemiology
• Public Health

Background:

• Limited data exists on long-term survival and recurrence rates following ischemic stroke.
• Understanding time trends stratified by etiological subtype is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate time trends in ischemic stroke case-fatality and recurrence rates over a 20-year period.
• To stratify these trends by etiological subtype using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification.

Main Methods:

• Prospective, population-based stroke register (Erlangen Stroke Project) data from 1996-2015.
• Kaplan-Meier estimates for 3-month, 1-year, and 5-year survival and recurrence rates.
• Cox regression analysis adjusted for age, sex, and year of event, stratified by etiological subtypes.

Main Results:

• Overall 5-year survival improved over 20 years, but varied by stroke cause (e.g., higher in small-artery occlusion, lower in cardioembolic stroke).
• Five-year recurrence rates were approximately 20% for both sexes and showed minimal variation by stroke cause.
• Case-fatality rates improved over time, with differences observed across stroke etiologies.

Conclusions:

• Long-term survival after ischemic stroke has improved significantly over the past two decades.
• Stroke recurrence rates have not shown significant trends over the same period.
• Etiological subtype is a critical factor influencing both survival and recurrence probabilities after ischemic stroke.