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Multicenter Study
. 2020;17(4):487-494.
doi: 10.2174/1567202617666200817141837.

Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry

Haiqiang Qin  1 , Penglian Wang  1 , Runhua Zhang  1 , Miaoxin Yu  1 , Guitao Zhang  1 , Gaifen Liu  1 , Yongjun Wang  1
Affiliations
Multicenter Study

Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry

Haiqiang Qin et al. Curr Neurovasc Res. 2020.

Abstract

Background: There is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis.

Methods: We analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic stroke.

Results: A total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR 1.49,95% CI 1.34-1.66) at 1 year.

Conclusion: After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific causes of poor prognosis in patients with history of stroke need to be furtherly investigated.

Keywords: Ischemic stroke; disability; mortality; prognosis; registry; risk factors.

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Figures

Fig. (1)
Fig. (1)
flowchart for ischemic stroke patients with and without stoke history. A total of 22,216 patients were enrolled in CNSR. First, 3636 patients were excluded due to transfers from other hospitals, no consent for follow up, incomplete demographic baseline information, and diagnosis as undetermined. Second, 5234 patients were excluded because of the diagnosis of haemorrhagic cerebrovascular diseases. In addition, 1201 patients were excluded because of the diagnosis of TIA. Finally, 12,415 patients with ischemic stroke, including 8181 without stroke history and 4234 with, were included in this study for analysis. Abbreviations: CNSR, China National Stroke Registry; TIA, Transient Ischemic Attack.
Fig. (2)
Fig. (2)
Subgroup analysis of 12-month mortality of patients with and without stroke history. *adjusted OR had been adjusted for potential confounders including age, gender, history of hypertension, dyslipidemia, diabetes mellitus, coronary heart disease and atrial fibrillation, family history of stroke, smoking, drinking, modified Rankin scale before stroke onset, NIHSS, medicine use before admission (anticoagulant, antiplatelet, antihypertensive, dyslipidemia, management of diabetes mellitus) and during hospitalization (tissue-type plasminogen activator, anticoagulant, antiplatelet, dyslipidemia, management of diabetes mellitus), and complications during hospitalization (urinary tract infection, pneumonia, gastrointestinal bleeding). Abbreviations: OR, odds ratio; BMI, Body Mass Index; NIHSS, National Institutes of Health Stroke Scale; GCS, Glasgow Coma Scale.
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