Burden and outcome of prevalent ischemic brain disease in a national acute stroke registry.
OBJECTIVE
Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke.


METHODS
Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010) with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification.


RESULTS
Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke. Adjusted odds ratios (OR; 95% confidence interval [CI]) for disability were increased for patients with prior overt stroke (OR, 1.31; 95% CI, 1.03-1.66) and subclinical stroke (OR, 1.45; 95% CI, 1.16-1.82). Relative odds of Barthel Index≤60 for patients with prior overt stroke (OR, 2.04; 95% CI, 1.14-3.68) and with prior subclinical stroke (OR, 2.04; 95% CI, 1.15-3.64) were twice higher than for patients with a first stroke. ORs for dependency were significantly increased for patients with prior overt stroke (OR, 1.95; 95% CI, 1.19-3.20) but not for those with subclinical stroke (OR, 1.36; 95% CI, 0.84-2.19).


CONCLUSIONS
In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.
From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (S.K., D.T.); Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel (R.T., N.M., D.T.); Department of Neurology, Kaplan Medical Center, Rechovot, Israel (M.K., A.E.); and Department of Neurology, Rivka Ziv Medical Center, Zefat, Israel (R.S.).
Silvia
S
Koton
Rakefet
R
Tsabari
Noa
N
Molshazki
Moshe
M
Kushnir
Radi
R
Shaien
Anda
A
Eilam
David
D
Tanne
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000401:mortality*; D015996:Survival Rate
follow-up; ischemic stroke; mortality; national registry; outcome; silent brain infarction; subclinical stroke