Risk of recurrent stroke, myocardial infarction, or death in hospitalized stroke patients

Abstract

Objective: This study examines the risk of recurrent stroke, myocardial infarction (MI), vascular death, or all-cause death after hospitalized stroke in South Carolina.

Methods: Patients with a primary diagnosis of stroke discharged from the year 2002 were identified from the state hospital discharge database. Kaplan-Meier estimates of recurrent stroke, MI, vascular death, all-cause death, and composite events were calculated at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years. Prognostic factors were assessed with multivariate Cox proportional hazard models.

Results: The search strategy identified 10,399 patients in 2002. The Kaplan-Meier estimate of cumulative risk at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years for recurrent stroke is 1.8%, 5.0%, 8.0%, 12.1%, 15.2%, and 18.1%; MI, 0.3%, 1.0%, 2.1%, 3.7%, 5.0%, and 6.2%; all-cause death, 14.6%, 20.6%, 24.5%, 30.9%, 36.2%, and 41.3%; vascular death, 11.4%, 14.8%, 17.1%, 20.7%, 23.8%, and 26.7%; and composite events of recurrent stroke, MI, or vascular death 13.6%, 19.5%, 24.7%, 31.6%, 36.8%, and 41.3%. The hazard ratio for composite events (recurrent stroke, MI, or death) increases with age (1.38, 1.35–1.41), is 1.12 (1.05–1.19) for African Americans compared to Caucasians, is 1.67 (1.57–1.77) for patients with a higher comorbidity index (≥2 vs <2), and is 1.34 (1.28–1.39) for patients with subarachnoid hemorrhage or intracerebral hemorrhage compared with ischemic stroke.

Conclusions: These findings suggest there is room for further improvement in secondary stroke prevention in South Carolina.