Early time to first recurrence predicts multiple recurrent ischemic strokes: A 2.5-year prospective cohort study

Ischemic stroke carries a significant risk of recurrence. Identifying individuals at highest risk for multiple recurrences is crucial for optimizing secondary prevention strategies.

In this prospective cohort study, we enrolled 5,415 patients with first-ever ischemic stroke. Subjects (N = 5,040) were followed up quarterly for 2.5 years. We documented the occurrence and timing of any recurrent ischemic stroke events, along with medication adherence.

Over the follow-up period, 425 patients (8.43%) experienced at least one recurrence. Among these, 365 had a single recurrence (7.24%) and 60 had multiple recurrences (≥2 events). A significantly shorter mean time to first recurrence was observed in the multiple-recurrence group compared to the single-recurrence group (11.77 ± 9.50 vs. 17.19 ± 12.46 months, P = 0.008). Multivariable logistic regression confirmed time to first recurrence as an independent predictor of multiple recurrences (adjusted OR 0.965 per month increase, 95% CI: 0.933-0.998, P = 0.036). Using receiver operating characteristic analysis, a time-to-first-recurrence threshold of 6.65 months was identified. Using receiver operating characteristic analysis, a time-to-first-recurrence threshold of 6.65 months was identified. Recurrence within this cutoff was significantly associated with an increased risk of subsequent multiple strokes (adjusted OR for longer time to recurrence (OR 0.704, 95% CI: 0.535-0.927, P = 0.012).

In our cohort, one in seven patients with a recurrent stroke went on to experience multiple recurrences. An early first recurrence, particularly within 6.65 months of the index stroke, is a strong predictor of this high-risk pattern. These patients warrant prioritized and intensified secondary prevention management.