Stroke: prior stroke, diastolic hypertension and diabetes increased the risk of recurrent stroke.

Clinical bottom line (level 1b-)

  1. A tenth of patients who had a cerebral infarction had a recurrent stroke within a mean of 13 months.
  2. Patients with cerebral infarction were at an increased risk of recurrent stroke at a mean of 13 months if they had a history of diabetes, diastolic hypertension or a prior stroke.
  3. Patients with cerebral infarction were at a decreased risk of recurrent stroke if they had an infarct of unknown cause.
Hier et al: Stroke 1991; 22: 155-161
Expires December 2002

The study

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

Setting: population-based, USA

1273 patients (aged ?, 52% female) index stroke diagnosed as cerebral infarction

Excluded if
  • deteriorations associated with cerebral oedema, hypoperfusion, metabolic disturbance, toxemia, fever, epilepsy or postictal states
  • strokes related to surgery, angiography or anticoagulant treatment



    • Factors studied:
  • recurrent stroke
  • history of diabetes
  • diastolic hypertension = 100 mmHg
  • prior stroke
  • infarct of unknown cause




    • Multivariate analysis was used to adjust for confounding factors

    100% followed for median 13 months
    Outcomes studied:
  • recurrent stroke cerebrovascular event subsequent to the index stroke with one of the following: produced a neurological deficit different from index stroke; event occurred in an anatomic site or vascular territory different from index stroke; stroke subtype different from index stroke

    • 58% of patients were black, 34% were white and 8% were of another racial group.

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    recurrent stroke median 13 months 129/1273 10.1%
    (8.48% to 11.8%)

    prognostic factor for
    recurrent stroke     		time to outcome adjusted RR
    (95% CI)
    history of diabetes median 13 months 1.66
    (1.14 to 2.42)
    diastolic hypertension median 13 months 1.01
    (1.00 to 1.02)
    prior stroke median 13 months 1.74
    (1.19 to 2.55)
    infarct of unknown cause median 13 months 0.60
    (0.40 to 0.89)

    Comments

    1. Relative risks were described as estimates, and NNF+s could not be calculated as recurrence rates were based on 2-year cumulative rate (mean follow-up was only 13 months).

    Citation

    1. Hier DB, Foulkes MA, Swiontoniowski M, et al: Stroke recurrence within 2 years after ischemic infarction. Stroke 1991; 22: 155-161
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient ischaemic infarction
    Intervention or Exposure presence of prognostic factors
    Comparison absence of prognostic factors
    Outcome stroke recurrence