Five-year prognosis after mild to moderate ischemic stroke by stroke subtype: a multi-clinic registry study

• Published in: PloS one 2013-11, Vol.8 (11), p.e75019-e75019
• Main Authors: Lv, Yumei, Fang, Xianghua, Asmaro, Karam, Liu, Hongjun, Zhang, Xinqing, Zhang, Hongmei, Qin, Xiaoming, Ji, Xunming
• Format: Article
• Language: English
• Subjects: Aged; Alcoholic beverages; Body mass; Body mass index; Body size; Cardiac patients; Case-Control Studies; Cerebral infarction; Clinics; Confidence intervals; Coronary artery disease; Death; Depression (Mood disorder); Diabetes; Diabetes mellitus; Dyslipidemia; Enrollments; Female; Hazards; Health risks; Heart diseases; Hospitals; Humans; Hypertension; Identification methods; Infarction; Ischemia; Kaplan-Meier Estimate; Male; Medical prognosis; Medical research; Mental depression; Middle Aged; Mortality; Neurology; NMR; Nuclear magnetic resonance; Patients; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Recurrence (Disease); Registries; Rehabilitation; Research methodology; Risk analysis; Risk Factors; Risk management; Smoking; Statistical analysis; Stroke; Stroke, Lacunar - mortality; Stroke, Lacunar - pathology; Stroke, Lacunar - prevention & control; Studies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0075019

Mild to moderate ischemic stroke is a common presentation in the outpatient setting. Among the various subtypes of stroke, lacunar infarction (LI) is generally very common. Currently, little is known about the long-term prognosis and factors associated with the prognosis between LI and non-LI. This study aims to compare the risk of death and acute cardiovascular events between patients with LI and non-LI, and identify potential risk factors associated with these outcomes. A total of 710 first-ever ischemic stroke patients (LI: 474, non-LI: 263) from 18 clinics were recruited consecutively from 2003 to 2004. They were prospectively followed-up until the end of 2008. Hazard ratios and 95% confidence intervals were calculated using multivariable Cox proportional hazards regression. After a 5-year follow up, 54 deaths and 96 acute cardiovascular events occurred. Recurrent stroke was the most common cause of death (19 cases, 35.18%) and new acute cardiovascular events (75 cases, 78.13%). There were no significant differences between patients with LI and non-LI in their risks of death, new cardiovascular events, and recurrent stroke after adjusting for age, sex, hypertension, diabetes, cardiac diseases, body mass index, dyslipidemia, smoking, alcohol consumption, ADL dependence, and depressive symptoms. Among the modifiable risk factors, diabetes, hypertension, ADL dependency, and symptoms of depression were independent predictors of poor outcomes in patients with LI. In non-LI patients, however, no modifiable risk factors were detected for poor outcomes. Long-term outcomes did not differ significantly between LI and non-LI patients. Detecting and managing vascular risk factors and depression as well as functional rehabilitation may improve the prognoses of LI patients.