Stroke: old age, minor disability, prior MI, nonvalvular atrial fibrillation and high cholesterol increased the risk of death.

Clinical bottom line (level 1b)

  1. A third of patients who had a minor stroke were dead at 10 years.
  2. Patients who had a minor stroke were at an increased risk of death at 10 years if they were older than 65 years, had a minor disability, had prior MI, had nonvalvular atrial fibrillation or were hypercholesterolaemic.
  3. A tenth of patients who had a minor stroke had a major stroke at 10 years.
  4. Patients who had a minor stroke were at an increased risk of a major stroke recurrence at 10 years if they had recurrent minor strokes, a lacunar stroke, a prior MI or were hypertensive.
Prencipe et al: Stroke 1998; 29: 126-132
Expires December 2002

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: neurological department in a university hospital, Italy

322 patients (aged median 55 years, 76% male) first-ever stroke (signs and symptoms lasting >24 hours) with minor or no disability (score <3 on modified Rankin scale) within 30 days of onset, and admission within 48 hours of onset

Excluded if
  • cranial CT scan not excluding haemorrhagic or other nonvascular lesions
  • life-threatening disease within 2 years of discharge
  • residence in or around the city where the hospital was located
  • no consent
  • suffered from deficits caused by new strokes, cerebral angiography or carotid endarterectomy within 30 days of stroke onset
  • inappropriate CT ischaemic lesions



    • Factors studied:
  • death and major recurrent stroke
  • age > or = 65 years
  • minor disability
  • prior MI
  • nonvalvular atrial fibrillation
  • hypercholesterolaemia
  • recurrent minor strokes
  • lacunar stroke
  • prior MI
  • hypertension


    • 75% of patients were treated with antiplatelet drugs, 8% with oral anticoagulants and 6% were given carotid endarterectomy and subsequently treated with antiplatelet drugs. 11% did not take antiplatelets or anticoagulants.

    Cox proportional hazard model was used to aqdjust for confounding factors.

    94% followed for 10 years
    Outcomes studied:
  • death due to any cause
  • major stroke recurrence

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death 10 years 96/322 29.8%
    (24.8% to 34.8%)
    major stroke recurrence 10 years 37/322 11.5%
    (8.01% to 15.0%)

    prognostic factor for
    death     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    age > or = 65 years 10 years 22/237
    (9.28%)     		1.07
    (1.05 to 1.09)     		171
    (133 to 239)
    minor disability 10 years 18/185
    (9.73%)     		3.40
    (2.20 to 5.20)     		6
    (4 to 11)
    prior MI ? 1.80
    (1.10 to 3.10)
    nonvalvular atrial fibrillation ? 2.00
    (1.10 to 3.70)
    hypercholesterolaemia 10 years 27/186
    (14.5%)     		1.80
    (1.20 to 2.70)     		11
    (6 to 42)

    prognostic factor for
    major stroke recurrence     		time to outcome control rate (%) adjusted OR
    (95% CI)    		 NNF+
    (95% CI)
    recurrent minor strokes ? 2.80
    (1.30 to 6.20)
    lacunar stroke 10 years 17/207
    (8.21%)     		3.10
    (1.90 to 4.60)     		7
    (5 to 16)
    prior MI ? 2.90
    (1.30 to 6.80)
    hypertension 10 years 7/148
    (4.73%)     		3.00
    (1.40 to 6.40)     		12
    (5 to 57)

    Comments

    1. Not enough data was given to calculate all of the NNF+s.

    Citation

    1. Prencipe M, Culasso F, Rasura M, et al: Long-term prognosis after a minor stroke: 10-year mortality and major stoke recurrence rates in a hospital-based cohort. Stroke 1998; 29: 126-132
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient minor ischaemic ischemicroke
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome major stroke or death