Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;23(1):51-60.
doi: 10.5853/jos.2020.03391. Epub 2021 Jan 31.

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Yuesong Pan  1   2 , Zixiao Li  1   2 , Jiejie Li  1   2 , Aoming Jin  1   2 , Jinxi Lin  1   2 , Jing Jing  1   2 , Hao Li  1   2 , Xia Meng  1   2 , Yilong Wang  1   2 , Yongjun Wang  1   2
Affiliations

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

Yuesong Pan et al. J Stroke. 2021 Jan.

Abstract

Background and purpose: Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.

Methods: Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.

Results: Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.

Conclusions: There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Keywords: Outcome; Risk factors; Secondary prevention; Stroke.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow chart of study population. TIA, transient ischemic attack; CNSR-III, Third China National Stroke Registry; MRI, magnetic resonance imaging; LDL-C, low-density lipoprotein cholesterol; hsCRP, high-sensitive C-reactive protein; IL-6, interleukin-6.
Figure 2.
Figure 2.
Residual risk of recurrent stroke in different scenarios. IL-6, interleukin-6; ICAS, intracranial artery stenosis.
See this image and copyright information in PMC

References

    1. Chen Y, Wright N, Guo Y, Turnbull I, Kartsonaki C, Yang L, et al. Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults. Lancet Glob Health. 2020;8:e580–e590. - PMC - PubMed
    1. Lin B, Zhang Z, Mei Y, Wang C, Xu H, Liu L, et al. Cumulative risk of stroke recurrence over the last 10 years: a systematic review and meta-analysis. Neurol Sci. 2020 Oct 10; doi: 10.1007/s10072-020-04797-5. [Epub]. - DOI - PubMed
    1. Wang Y, Li Z, Zhao X, Wang C, Wang X, Wang D, et al. Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: a randomized clinical trial. JAMA. 2018;320:245–254. - PubMed
    1. Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374:1533–1542. - PubMed
    1. Xie X, Wang X, Li Z, Zhao X, Miao Z, Liu L, et al. Prognostic value of international normalized ratio in ischemic stroke patients without atrial fibrillation or anticoagulation therapy. J Atheroscler Thromb. 2019;26:378–387. - PMC - PubMed