BACKGROUND: This study aimed to determine case fatality and short-term and long-term effects of complications in individuals who were admitted to a community-based hospital due to acute ischemic stroke or transient ischemic attack (TIA). METHODS: Between November 1998 and February 2001, all individuals with a suspected ischemic stroke or TIA, who admitted to Eulji General Hospital within 7 days from symptom onset, were registered prospectively and consecutively. Complications following stroke were defined as any comorbidities, including urinary tract infections, pneumonia, hemorrhages, ischemic heart disease, bed sore, fracture, etc. Case fatality was assessed by the national death certificate data from 1999 to 2001. RESULTS: Six-hundred thirty-one patients (mean age, 64.7 +/- 11.8 years; 309 males, 49%) with acute ischemic stroke or TIA were registered during 28 months. Duration of observation was 556.7 +/- 282.4 days. Thirty-day, 3-month, 1-year, and 2-year case fatalities were 5.1%. 10.1%, 18.3%, and 26.2% respectively. In subjects with complications, 30-day, 1-year, and 2-year case fatalities were 17.4%, 47.9%, and 58.4% respectively, while 0.7%, 7.6%, and 14.1% in subjects without complications (p<0.001). The presence of complications was a significant predictor of mortality following stroke (hazard ratio, 2.26) independent of age, sex, modified rankin disability score, NIH stroke scale at admission, TOAST classification, and risk factors of stroke. CONCLUSIONS: After acute ischemic stroke or TIA, 73.8% of patients survived more than 2 years. The occurrence of complications following stroke is an independent and strong predictor of short-term and long-term survival after acute ischemic stroke or TIA.