Relationship of functional disability after a recent stroke with recurrent stroke risk.
OBJECTIVE
Post-stroke disability status is primarily focused on recovery prognostication but the influence of post-stroke disability on future vascular risk is unknown. The relationship between functional disability after an index stroke and risk of recurrent vascular events was examined.


METHODS
A cohort analysis of 3680 recent non-cardioembolic, non-to-moderate disabled [modified Rankin Scale (mRS) ≤3] stroke patients aged ≥35 years and followed for 2 years was reviewed. The mRS measured at a median of 35 days after the index stroke was analyzed as a dichotomous variable (mRS 3 vs. ≤2) and in a stepwise manner. Independent associations of post-stroke disability by mRS score with ischaemic stroke (primary outcome), stroke/coronary heart disease/vascular death as major vascular events (secondary outcome) and all-cause death (tertiary outcome) were analyzed.


RESULTS
Amongst study participants, 435 (11.8%) had an mRS of 3. Compared with mRS ≤2 as no/slight disability, mRS 3 as moderate disability was associated with a higher risk of stroke (adjusted hazard ratio 1.45, 95% confidence interval 1.06-1.99). Compared with mRS 0, there was a progressively higher independent risk for each of the study outcomes: stroke, mRS 1 (1.42, 0.97-2.08), mRS 2 (1.46, 0.97-2.20), mRS 3 (1.89, 1.20-2.97); major vascular events, mRS 1 (1.31, 1.01-1.70), mRS 2 (1.31, 0.99-1.74), mRS 3 (1.46, 1.06-2.01); and all-cause death, mRS 1 (1.75, 1.03-2.98), mRS 2 (2.49, 1.44-4.31), mRS 3 (2.72, 1.43-5.19).


CONCLUSIONS
Compared with no/slight disability, moderate disability after a recent stroke is linked to a higher risk of recurrent stroke.
Department of Neurology, Seonam University Myongji Hospital, Goyang, South Korea.|Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.
J-H
JH
Park
Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA.
B
B
Ovbiagele
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology
disability; ischaemic stroke; modified Rankin Scale; risk; vascular outcome