J Stroke.  2021 Jan;23(1):51-60. 10.5853/jos.2020.03391.

Residual Risk and Its Risk Factors for Ischemic Stroke with Adherence to Guideline-Based Secondary Stroke Prevention

• Pan Y
• Li Z
• Li J
• Jin A
• Lin J
• Jing J
• Li H
• Meng X
• Wang Y
• Wang Y

• KMID: 2512354
• DOI: http://doi.org/10.5853/jos.2020.03391

Abstract

Background and Purpose
Despite administration of evidence-based therapies, residual risk of stroke recurrence persists. This study aimed to evaluate the residual risk of recurrent stroke in acute ischemic stroke or transient ischemic attack (TIA) with adherence to guideline-based secondary stroke prevention and identify the risk factors of the residual risk.
Methods
Patients with acute ischemic stroke or TIA within 7 hours were enrolled from 169 hospitals in Third China National Stroke Registry (CNSR-III) in China. Adherence to guideline-based secondary stroke prevention was defined as persistently receiving all of the five secondary prevention medications (antithrombotic, antidiabetic and antihypertensive agents, statin and anticoagulants) during hospitalization, at discharge, at 3, 6, and 12 months if eligible. The primary outcome was a new stroke at 12 months.
Results
Among 9,022 included patients (median age 63.0 years and 31.7% female), 3,146 (34.9%) were identified as adherence to guideline-based secondary prevention. Of all, 864 (9.6%) patients had recurrent stroke at 12 months, and the residual risk in patients with adherence to guidelinebased secondary prevention was 8.3%. Compared with those without adherence, patients with adherence to guideline-based secondary prevention had lower rate of recurrent stroke (hazard ratio, 0.85; 95% confidence interval, 0.74 to 0.99; P=0.04) at 12 months. Female, history of stroke, interleukin-6 ≥5.63 ng/L, and relevant intracranial artery stenosis were independent risk factors of the residual risk.
Conclusions
There was still a substantial residual risk of 12-month recurrent stroke even in patients with persistent adherence to guideline-based secondary stroke prevention. Future research should focus on efforts to reduce the residual risk.

Keyword

Outcome; Secondary prevention; Risk factors; Stroke

Figure

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  Figure 1. Flow chart of study population. TIA, transient ischemic attack; CNSR-III, Third China National Stroke Registry; MRI, magnetic resonance imaging; LDL-C, low-density lipoprotein cholesterol; hsCRP, high-sensitive C-reactive protein; IL-6, interleukin-6.

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  Figure 2. Residual risk of recurrent stroke in different scenarios. IL-6, interleukin-6; ICAS, intracranial artery stenosis.

Reference

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