The natural history of stroke recurrence after first-ever stroke

• Main Author: Mohan, Keerthi Michelle
• Format: Dissertation
• Language: English
• Published: King's College London 2016

Background - The natural history, predictors and outcomes of stroke recurrence after first-ever stroke have been insufficiently investigated. The available evidence shows great variation and does not provide a consensus of key predictors of stroke recurrence or a critical time-period for stroke recurrence occurring after initial stroke. This thesis uses data collected from the population-based South London Stroke Register to estimate the natural history of stroke recurrence after first-ever stroke. Methods - Data were collected over 12 years from all individuals known to have had an initial and first recurrent stroke from the South London Stroke Register. The cumulative risk and predictors of stroke recurrence up to 12 years after first stroke were identified using survival analyses, taking into account the effect of temporal changes in stroke management. The effect of stroke recurrence on risk of death after first stroke was estimated up to 15 years after initial stroke. A systematic review and meta-analysis of studies of the risk and cumulative risk of stroke recurrence after first stroke was also conducted. Results - The risk of stroke recurrence was estimated to be up to 25% at 12 years after first stroke. Cardiovascular risk factors were found to be important predictors of stroke recurrence, however differences in risk of recurrence were noted between the aetiological subtypes. Stroke recurrence was demonstrated to increase risk of death at all time-points up to 15 years after first stroke. Conclusions – The risk of stroke recurrence is considerable and is associated with increased risk of death up to 15 years after first stroke. Further research is needed to examine the effect of secondary prevention on risk of recurrence. Recurrence in the first year after stroke may also be associated with the biggest increase in risk of death identifying a potentially important time-period for stroke management to be targeted.