title: Neurologic symptom severity after a recent noncardioembolic stroke and recurrent vascular risk.
abstract: BACKGROUND
  There is a well-established relation of symptom severity with functional status and mortality after an index stroke. However, little is known about the impact of symptom severity of a recent index stroke on risk of recurrent vascular events.
  
  
  METHODS
  We reviewed the data set of a multicenter trial involving 3680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Independent associations of stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 versus ≥4) and a continuous variable.
  
  
  RESULTS
  Among study subjects, 550 (15%) had NIHSS scores of 4 or more (overall scores ranged from 0 to 18, median score was 1 [25th-75th percentile 0-2]). NIHSS was measured at a median of 35 days after the index stroke. After adjusting for multiple covariates, NIHSS of 4 or more was independently linked to a higher risk of recurrent stroke (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.01-1.84) and risk of stroke/CHD/vascular death (HR, 1.32; 95% CI, 1.07-1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of recurrent stroke (HR, 1.06; 95% CI, 1.00-1.12) and stroke/CHD/vascular death (HR, 1.05; 95% CI, 1.01-1.09) with increasing index stroke symptom severity.
  
  
  CONCLUSIONS
  Greater residual symptom severity after a recent stroke is associated with higher risk of recurrent vascular events. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms.
authors: Department of Stroke Neurology, Myongji Hospital, Goyang, Korea; Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.
authors: Jong-Ho
authors: JH
authors: Park
authors: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina. Electronic address: Ovibes@musc.edu.
authors: Bruce
authors: B
authors: Ovbiagele
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications*; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000517:prevention & control; D013997:Time Factors; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D014815:Vitamins; D001241:Aspirin
keywords: National Institutes of Health Stroke Scale; ischemic stroke; risk; vascular events