LONG-TERM PROGNOSIS AFTER A MINOR STROKE - 10-YEAR MORTALITY AND MAJOR STROKE RECURRENCE RATES IN A HOSPITAL-BASED COHORT

Background and Purpose-Determinants of long-term outcome are not well defined in minor stroke patients. This study aims to evaluate which fa ctors are independent long-term predictors of death and major-stroke r ecurrence in a cohort of minor ischemic strokes. Methods-A cohort of 3 22 patients with first-ever minor ischemic strokes (mean age, 55 years ; 89% were treated with antiplatelet or anticoagulant drugs) with mino r (Rankin score=2) or no disability (Rankin score <2) were followed fo r 10 years, with only 6% lost to follow-up. Death and major stroke rec urrence rates were evaluated by Kaplan-Meier analysis. Hazard ratios a nd 95% confidence intervals (Cl) of factors with P<.1 al. the log-rank test were evaluated bf multivariate Cox analysis. Results-The 10-year mortality rate was 32%, with a relative risk of 1.7 (95% Cl, 1.4 to 2 .1) compared with the age- and sex-matched general population. The 10- year recurrence rate of major strokes was 14%. The hazard ratio (95% C I) of death was 1.1 (1.05 to 1.09) for age (I-year increments), 3.4 (2 .2 to 5.7) for minor disability, 1.8 (1.1 to 3.1) for myocardial infar ction (MI), 2.0 (1.1 to 3.7) for nonvalvular atrial fibrillation, and 1.8 (1.2 to 2.7) for hypercholesterolemia. The hazard ratio (95% CI) o f major stroke recurrence was 2.5 (1.3 to 6.2) for recurrent minor str okes, 3.1 (1.9 to 4.6) for nonlacunar stroke, 2.9 (1.3 to 6.8) for MI, and 3.0 (1.4 to 6.4) for hypertension. Conclusions-In minor ischemic strokes, age, minor disability, MI, nonvalvular atrial fibrillation, a nd hypercholesterolemia increase the risk of death: recurrent minor st rokes, nonlacunar stroke, MI, and hypertension increase the risk of ma jor stroke.