PREDICTORS OF MORTALITY AND RECURRENCE AFTER HOSPITALIZED CEREBRAL INFARCTION IN AN URBAN-COMMUNITY - THE NORTHERN MANHATTAN STROKE STUDY

Objective: To identify determinants of recurrence and mortality after ischemic stroke in a mixed-ethnic region. Background: The determinants of ischemic stroke outcome are not uniformly characterized and will b e of increasing importance as the frequency of ischemic stroke survivo rs increases in our aging population. Methods: A cohort of 323 patient s (40% black, 34% Hispanic, 26% white) with cerebral infarction from n orthern Manhattan over age 39 were followed for a mean of 3.3 years, w ith only 6% lost to follow-up. Cumulative life table risk of mortality and recurrence was calculated. Risk factors classified at the time of index ischemic stroke were selected based on univariate analyses and then entered into a Cox proportional hazards model for mortality and f or recurrence. Results: The life table cumulative risk of mortality wa s 8% at 30 days, 22% at 1 year, and 45% at 5 years after ischemic stro ke. The immediate cause of death was related to vascular disease in 60 %. After age adjustment, the significant predictors of mortality were congestive heart failure (risk ratio RR = 2.6), admission glucose >1 40 mg/dl (RR = 1.7), and presentation with either a large dominant, no ndominant, or major basilar syndrome (RR = 2.0). Patients with a lacun ar syndrome had a better survival (RR = 0.6). Recurrent strokes occurr ed in 72 patients. The life table cumulative risk of recurrence was 6% at 30 days, 12% at 1 year, and 25% at 5 years after ischemic stroke. Ethanol abuse (RR = 2.5), hypertension requiring discharge medications (RR = 1.6), and elevated blood glucose within 48 hours of index ische mic stroke (RR = 1.2 per 50 mg/dl) were the independent predictors of recurrence. Among 30-day survivors, the effect of ethanol abuse was gr eater (RR = 3.5), indicating its impact on late recurrence. Conclusion s: After accounting for age and presenting syndrome, initial glucose p redicts stroke mortality and recurrence after ischemic stroke. This as sociation may reflect uncontrolled and undiagnosed diabetes in our urb an population. Furthermore, ethanol abuse may be a determinant of isch emic stroke recurrence. Reduction of the stroke public health burden w ill require targeted modification of such conditions and behaviors.