Risk and Cumulative Risk of Stroke Recurrence A Systematic Review and Meta-Analysis

被引:482
作者
Mohan, Keerthi M. [1 ]
Wolfe, Charles D. A. [1 ,2 ]
Rudd, Anthony G. [3 ]
Heuschmann, Peter U. [1 ,4 ]
Kolominsky-Rabas, Peter L. [5 ]
Grieve, Andrew P. [1 ]
机构
[1] Kings Coll London, Div Hlth & Social Care Res, London SE1 3QD, England
[2] Guys & St Thomas NHS Fdn Trust, NIHR Biomed Res Ctr, London, England
[3] Guys & St Thomas NHS Fdn Trust, St Thomas Hosp, Dept Care Elderly, London, England
[4] Charite, Ctr Stroke Res Berlin, D-13353 Berlin, Germany
[5] Univ Erlangen Nurnberg, Interdisciplinary Ctr Publ Hlth, Erlangen, Germany
关键词
frequency; predictors; recurrence; stroke; TRANSIENT ISCHEMIC ATTACK; PERTH COMMUNITY STROKE; LONG-TERM PROGNOSIS; 1ST-EVER STROKE; MINOR STROKE; EVER STROKE; SURVIVAL; PREDICTORS; PATTERNS; SUBTYPES;
D O I
10.1161/STROKEAHA.110.602615
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Estimates of risk of stroke recurrence are widely variable and focused on the short-term. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence. Methods-Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI. Results-Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115 survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7-4.4) at 30 days, 11.1% (95% CI, 9.0-13.3) at 1 year, 26.4% (95% CI, 20.1-32.8) at 5 years, and 39.2% (95% CI, 27.2-51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies. Conclusions-The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence. (Stroke. 2011;42:1489-1494.)
引用
收藏
页码:1489 / 1494
页数:6
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