LONG-TERM RISK OF FIRST RECURRENT STROKE IN THE PERTH COMMUNITY STROKE STUDY

Background and Purpose-Few community-based studies have examined the l ong-term risk of recurrent stroke after an acute first-ever stroke. Th is study aimed to determine the absolute and relative risks of a first recurrent stroke over the first 5 years after a first-ever stroke and the predictors of such recurrence in a population-based series of peo ple with first-ever stroke in Perth, Western Australia. Methods-Betwee n February 1989 and August 1990, all people with a suspected acute str oke or transient ischemic attack of the brain who were resident in a g eographically defined region of Perth, Western Australia, with a popul ation of 138 708 people, were registered prospectively and assessed ac cording to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index eve nt. Results-Three hundred seventy patients with a first-ever stroke we re registered, of whom 351 survived >2 days. Data were available for 9 8% of the cohort at 5 years, by which time 199 patients (58%) had died and 52 (15%) had experienced a recurrent stroke, 12 (23%) of which we re fatal within 28 days. The 5-year cumulative risk of first recurrent stroke was 22.5% (95% confidence limits [CL], 16.8%, 28.1%). The risk of recurrent stroke was greatest in the first 6 months after stroke, at 8.8% (95% CL, 5.4%, 12.1%). After adjustment for age and sex, the p rognostic factors for recurrent stroke were advanced, but not extreme, age (75 to 84 years) (hazard ratio [HR], 2.6; 95% CL, 1.1, 6.2), hemo rrhagic index stroke (HR, 2.1; 95% CL, 0.98, 4.4), and diabetes mellit us (HR, 2.1; 95% CL, 0.95, 4.4). Conclusions-Approximately 1 in 6 surv ivors (15%) of a first-ever stroke experience a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days. The pathologi cal subtype of the recurrent stroke is the same as that of the index s troke in 88% of cases. The predictors of first recurrent stroke in thi s study were advanced age, hemorrhagic index stroke, and diabetes mell itus, but numbers of recurrent events were modest. Because the risk of recurrent stroke is highest (8.8%) in the first 6 months after stroke , strategies for secondary prevention should be initiated as soon as p ossible after the index event.