Stroke: lacunar: the long-term risk of death and recurrent stroke was high

Clinical bottom line (level 1b)

  1. 60% of patients with a first pure motor stroke died within 10 years.
  2. The risk of dying was increased with
    • increasing age
    • female sex
    • no use of aspirin
  3. A quarter had a recurrent stroke within 10 years.
  4. The risk of recurrent stroke was increased with
    • hypertension
    • diabetes mellitus
Staaf et al: Stroke 2001; 32 : 2592-2596
Expires June 2004

The study

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

Setting: outpatient clinic,university hospital, Sweden

180 patients (aged 28 to 97; mean 73, 57% male) with a first pure motor stroke

Factors studied:
  • age, sex, hypertension, diabetes mellitus, cardiac risk factors, smoking , severity of stroke, regular use of aspirin


    Cox proportional hazards regression analysis was used to adjust for confounding factors.

    99% followed for 10 years

    Outcomes studied:
    • death
    • recurrent stroke

      The evidence

      outcome time to outcome number of patients/total number %
      (95% CI)      		 NNF
      (95% CI)
      death 10 years 106/178 60%
      (52% to 67%)      		 2
      (1 to 2)
      recurrent stroke 10 years 42/178 24%
      (17% to 30%)      		 4
      (3 to 6)

        • Death was independently associated with
          • increasing age
          • female sex
          • no aspirin medication
        • Recurrent stroke was independently associated with
          • hypertension
          • diabetes mellitus

      Comments

      1. Though the risk of death was similar to the general Swedish population in the first few years, the risk increased substantially over time.

      Citation

      1. Staaf G, Lindgren A, Norrving B: pure motor stroke from presumed lacunar infarct: long-term prognosis for survival and risk of recurrent stroke. Stroke 2001; 32 : 2592-2596
      Search Terms: from ACP Journal Club other articles noted
      Contributor: Chris Ball, June 2002
      Reviewer:

      Clinical Question.
      Patient first pure motor stroke
      Intervention or Exposure cardiac risk factors
      Outcome death, recurrent stroke