Rate of stroke recurrence in patients with primary intracerebral hemorrhage

Background and Purpose-Primary intracerebral hemorrhage (PICH) is a devasta ting illness with high early mortality. Hypertension is a major risk factor both for ischemic cerebrovascular disease and for intracranial hemorrhage. Survivors of PICH are at risk for both recurrent hemorrhage and ischemic c erebrovascular disease. We sought to determine the rate of recurrence of IC H or cerebral ischemia in a cohort of PICH patients at the Toronto Hospital , Toronto, Canada. Methods-A retrospective search of computerized hospital records from 1986 t o 1996 for patients with a discharge diagnosis of intracerebral hemorrhage (International Classification of Diseases, Ninth Revision-Clinical Modifica tion [ICD-9-CM] code 431) was conducted to identify the index cases. Charts were abstracted for demographic and clinical characteristics. CT scans, MR scans, or radiologist reports were reviewed. To determine recurrence, the database was linked to the Ontario Provincial Government Vital Statistics R egistry and to the Canadian Institute for Health Information database of ho spital discharge abstracts. Logistic regression analysis was used to identi fy predictive factors for mortality after PICH. A Cox proportional hazards model was fitted to identify predictive factors for recurrent ICH or stroke . Results-A total of 746 charts were identified by computer search. After abs traction, 423 index patients with PICH were identified. Of these, 27.4% die d in the first 30 days of their admission. Predictors of death were age, in traventricular rupture of hemorrhage, and trilobar hemorrhage. The recurren ce rate for PICH was 2.4% (95% CI 1.4% to 3.9%) per year, whereas the recur rence rate for ischemic cerebrovascular disease was 3.0% (95% CI 1.8% to 4. 7%) per year. The only significant predictor of readmission for ICH was lob ar location of the index hemorrhage, with a hazard ratio of 3.8 (95% CI 1.2 to 12.0). Conclusions-PICH has a high 30-day mortality rate, Survival from the initia l insult portends a moderate risk of recurrence of 2.4% per year for PICH a nd 3.0% per year for ischemic cerebrovascular disease. Patients with PICH a re at risk for both ischemic stroke or TIA and recurrent hemorrhage; thus, PICH may be a marker for ischemic stroke. Patients with lobar hemorrhage ha ve a 3.8-fold increased risk of recurrent ICH.