Cause-specific mortality after first cerebral infarction: a population-based study.
OBJECTIVE
Mortality after cerebral infarction (CI) has remained unchanged during the past 20 years, despite advances in neurologic care. Key factors affecting survival may be underrecognized. The purpose of this study was to determine the rate and cause of mortality after first CI.


METHODS
In this case-control, population-based study, all available medical records were reviewed for Rochester (Minnesota) residents with a first CI between 1985 and 1989 to identify morbidities and cause of death. Predictors for mortality were analyzed.


RESULTS
First CI was recorded for 444 patients. Survival was 83% at 1 month, 71% at 1 year, and 46% at 5 years. The most frequent causes of death were cardiovascular events (22%), respiratory infection (21%), and initial stroke complications (14%). Recurrent stroke and cancer accounted for 9% and 7.5% of deaths, respectively. In the first month after CI, 51% of deaths were attributed to the initial CI, 22% to respiratory infections, and 12% to cardiovascular events. During the first year, 26% of deaths resulted from respiratory infections and 28% from cardiovascular disease. Mortality was higher among patients than controls for at least 2 years after CI. Age, cardiac comorbid conditions, CI severity, stroke recurrence, seizures, and respiratory and cardiovascular morbidities were independent predictors of death.


CONCLUSIONS
In the first month after CI, mortality resulted predominantly from neurologic complications. Later mortality remained high because of respiratory and cardiovascular causes. To improve long-term survival after CI, aggressive management of pulmonary and cardiac disease is as important as secondary stroke prevention.
Vernino
Steven
S
Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA.
Brown
Robert D
RD
Sejvar
James J
JJ
Sicks
JoRean D
JD
Petty
George W
GW
O'Fallon
W Michael
WM
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D016022:Case-Control Studies; D002423:Cause of Death; D002544:Cerebral Infarction / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate