Skip to content
naulon
Get started

No retraction, correction or concern found when last checked on Oct 23, 2026.

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

Andrej Netland Khanevski, Anna Therese Bjerkreim, Vojtech Novotny and 5 more

Acta Neurologica Scandinavica · 2019 · CC BY

doi:10.1111/ane.13093

Abstract

Background and purpose. Recurrent ischemic stroke (IS) or TIA is frequent with a considerable variation in incidence and mortality across populations. Current data on stroke recurrence and mortality are useful to examine trends, risk factors, and treatment effects. In this study, we calculated the incidence of recurrent IS or TIA in a hospital‐based stroke population in Western Norway, investigated recurrence factors, and estimated the effect of recurrence on all‐cause mortality.

Methods. This prospective cohort study registered recurrence and mortality among 1872 IS and TIA survivors admitted to the stroke unit at Haukeland University Hospital between July 2007 and December 2013. Recurrence and death until September 1, 2016, were identified by medical chart review. Cumulative incidences of recurrence were estimated with a competing risks Cox model. Multivariate Cox models were used to examine recurrence factors and mortality.

Results. During follow‐up, 220 patients had 277 recurrent IS or TIAs. The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% at the end of follow‐up. Hypertension (HR = 1.65, 95% CI 1.21‐2.25), prior symptomatic stroke (HR = 1.63, 95% CI 1.18‐2.24), chronic infarcts on MRI (HR = 1.48, 95% CI 1.10‐1.99), and age (HR 1.02/year, 95% CI 1.00‐1.03) were independently associated with recurrence. A total of 668 (35.7%) patients died during follow‐up. Recurrence significantly increased the all‐cause mortality (HR = 2.55, 95% CI 2.04‐3.18).

Conclusions. The risk of recurrent IS stroke or TIA was modest in our population and was associated with previously established risk factors. Recurrence more than doubled the all‐cause mortality.

References 26

  1. 1.

    Feigin VL, Lawes CM, Bennett DA, Barker‐Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population‐based studies: a systematic review. Lancet Neurol. 2009;8(4):355‐369.

    Not in our library10.1016/s1474-4422(09)70025-0

  2. 2.
    Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011 · 2016
    Not checked
  3. 3.

    Bergstrom L, Irewall AL, Soderstrom L, Ogren J, Laurell K, Mooe T. One‐year incidence, time trends, and predictors of recurrent ischemic stroke in Sweden from 1998 to 2010: an observational study. Stroke. 2017;48(8):2046‐2051.

    Not in our library10.1161/strokeaha.117.016815

  4. 4.

    Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky‐Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta‐analysis. Stroke. 2011;42(5):1489‐1494.

    Not in our library10.1161/strokeaha.110.602615

  5. 5.

    Boulanger M, Béjot Y, Rothwell Peter M, Touzé E. Long‐term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta‐analysis. J Am Heart Assoc. 2018;7(2):e007267.

    Not in our library10.1161/jaha.117.007267

  6. 6.

    Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population‐based study in Rochester, Minnesota, 1975 through 1989. Neurology. 1998;50(1):208‐216.

    Not in our library10.1212/wnl.50.1.208

  7. 7.

    Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Stroke recurrence: predictors, severity, and prognosis. The Copenhagen Stroke Study. Neurology. 1997;48(4):891‐895.

    Not in our library10.1212/wnl.48.4.891

  8. 8.

    Johnson CJ, Kittner SJ, McCarter RJ, et al. Interrater reliability of an etiologic classification of ischemic stroke. Stroke. 1995;26(1):46‐51.

    Not in our library10.1161/01.str.26.1.46

  9. 9.

    Allen LM, Hasso AN, Handwerker J, Farid H. Sequence‐specific MR imaging findings that are useful in dating Ischemic stroke. Radiographics, 2012;32(5):1285‐1297.

    Not in our library10.1148/rg.325115760

  10. 10.

    Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24(1):35‐41.

    Not in our library10.1161/01.str.24.1.35

  11. 11.

    Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337(8756):1521‐1526.

    Not in our library10.1016/0140-6736(91)93206-o

  12. 12.

    Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94(446):496‐509.

    Not in our library

  13. 13.

    Hankey GJ, Warlow CP. Treatment and secondary prevention of stroke: evidence, costs, and effects on individuals and populations. Lancet. 1999;354(9188):1457‐1463.

    Not in our library10.1016/s0140-6736(99)04407-4

  14. 14.

    OECD. Health Data: Pharmaceutical market, 2018. http://www.oecd.org/els/health-systems/health-data.htm.

    Not in our library

  15. 15.

    Lacny S, Wilson T, Clement F, et al. Kaplan‐Meier survival analysis overestimates cumulative incidence of health‐related events in competing risk settings: a meta‐analysis. J Clin Epidemiol. 2018;93:25‐35.

    Not in our library10.1016/j.jclinepi.2017.10.006

  16. 16.

    Amarenco P, Lavallée PC, Monteiro Tavares L, et al. Five‐year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378(23):2182‐2190.

    Not in our library10.1056/nejmoa1802712

  17. 17.

    Andersen SD, Gorst‐Rasmussen A, Lip GY, Bach FW, Larsen TB. Recurrent stroke: the value of the CHA2DS2VASc score and the Essen stroke risk score in a nationwide stroke cohort. Stroke. 2015;46(9):2491‐2497.

    Not in our library10.1161/strokeaha.115.009912

  18. 18.

    He VY, Condon JR, You J, Zhao Y, Burrow JN. Adverse outcome after incident stroke hospitalization for Indigenous and non‐indigenous Australians in the Northern Territory. Int J stroke. 2015;10(Suppl A100):89‐95.

    Not in our library10.1111/ijs.12600

  19. 19.

    Sun Y, Lee SH, Heng BH, Chin VS. Five‐year survival and rehospitalization due to stroke recurrence among patients with hemorrhagic or ischemic strokes in Singapore. BMC Neurol. 2013;13:133.

    Not in our library10.1186/1471-2377-13-133

  20. 20.

    Mohan KM, Crichton SL, Grieve AP, Rudd AG, Wolfe CD, Heuschmann PU. Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London stroke register. J Neurol Neurosurg Psychiatry. 2009;80(9):1012‐1018.

    Not in our library10.1136/jnnp.2008.170456

  21. 21.

    Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Long‐term risk of first recurrent stroke in the Perth community stroke study. Stroke. 1998;29(12):2491‐2500.

    Not in our library10.1161/01.str.29.12.2491

  22. 22.

    Pennlert J, Eriksson M, Carlberg B, Wiklund PG. Long‐term risk and predictors of recurrent stroke beyond the acute phase. Stroke. 2014;45(6):1839‐1841.

    Not in our library10.1161/strokeaha.114.005060

  23. 23.

    Gupta A, Giambrone AE, Gialdini G, et al. Silent brain infarction and risk of future stroke: a systematic review and meta‐analysis. Stroke. 2016;47(3):719‐725.

    Not in our library10.1161/strokeaha.115.011889

  24. 24.

    Aarnio K, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, Putaala J. Long‐term mortality after first‐ever and recurrent stroke in young adults. Stroke. 2014;45(9):2670‐2676.

    Not in our library10.1161/strokeaha.114.005648

  25. 25.

    Lisabeth LD, Smith MA, Brown DL, Moye LA, Risser JM, Morgenstern LB. Ethnic differences in stroke recurrence. Ann Neurol. 2006;60(4):469‐475.

    Not in our library10.1002/ana.20943

  26. 26.

    Weimar C, Konig IR, Kraywinkel K, Ziegler A, Diener HC; German Stroke Study C. Age and national institutes of health stroke scale score within 6 hours after onset are accurate predictors of outcome after cerebral ischemia: development and external validation of prognostic models. Stroke. 2004;35(1):158‐162.

    Not in our library10.1161/01.str.0000106761.94985.8b

Cited by papers we hold 1

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.