Abstract
The aim of this article was to study mortality following a first-ever cerebral infarct,
accounting for ischemic stroke subtypes (lacunar, cardioembolic, atherothrombotic)
and relevant prognostic variables. This study was done from s a hospital-based prospective
registry of all patients with a first cerebral infarct, with a high case ascertainment
of first and recurrent stroke by CT. We used a cross-sectional follow-up, using standardized
methods. Analyses were performed using crude comparison of mortality data and death
causes between stroke subtypes. We analyzed 30-day case fatality and 1-year mortality
in 30-day survivors by means of logistic regression analysis, and mortality in 1-year
survivors by means of Cox proportional hazard modeling. We also constructed Kaplan-Meier
survival curves, and used log-rank testing for differences between stroke subtypes.
Thirty-day case fatality was 10%, 1-year mortality 15%, and after 1-year mortality
16%. Mean follow-up was 691, SD 521 days. At the end of follow-up 36% of all patients
had died. Mortality was at all three time points lowest in lacunar stroke (2, 12,
and 14%, respectively), intermediate in atherothrombotic stroke (10, 16, and 15%,
respectively), and highest in cardioembolic stroke (23, 22, and 21%, respectively).
Death related to recurrent stroke was similar in all three stroke subtypes (13–16%).
Although 30-day case fatality rate was low in lacunar stroke, a quarter of lacunar
stroke patients had died at the end of follow-up. Diabetes mellitus, age, stroke subtype,
and initial stroke severity were independent predictors of 30-day case fatality, but
only diabetes and age were consistent independent predictors for later mortality.
Recurrent stroke and heart failure were important death causes. Prognosis for (future)
death following a first cerebral infarct differs between stroke subtypes; lacunar
stroke patients have the lowest mortality. However, lacunar stroke cannot be regarded
as a mild stroke type, as after 2 years more than a quarter of such stroke patients
had died. Cardioembolic stroke patients have the grimmest prognosis: more than half
of them had died within 1.5 years. Better prognosis for long-term survival following
stroke may be achieved by therapies which lower the risk of stroke recurrence, provide
better treatment of heart failure, or both.
Keywords
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Article info
Publication history
Accepted:
October 11,
2002
Received in revised form:
July 30,
2002
Received:
February 7,
2002
Identification
Copyright
© 2003 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
