Stroke recurrence and mortality in northeastern Greece: the Evros Stroke Registry

• DOI: 10.1007/s00415-018-9005-6
• Publication Date: 2018-08-20T02:23:26Z
• Authors: Georgios Tsivgoulis; Aristeidis H. Kat...; Athanasia Patousi; Maria Pikilidou; Theodosis Birbilis; Michael Mantatzis; Maria Yavropoulou; Christina Zompola; Sokratis Triantaf...; Nikolaos Papanas; Panagiotis Skendros; Aikaterini Terzoudi; George S. Georgiadis; Pantelis Zebekakis; Efstratios Maltezos; Charitomeni Piper...; Ioannis Heliopoulos; Konstantinos Vadi...
• Keywords: Adult; Aged, 80 and over; Male; Greece; Incidence; Middle Aged; Subarachnoid Hemorrhage; Brain Ischemia; 3. Good health; Stroke; 03 medical and health sciences; 0302 clinical medicine; Recurrence; Humans; Female; Prospective Studies; Aged; Cerebral Hemorrhage; Follow-Up Studies

Up to date there is no population-based study from Greece providing long-term data on incidence of both all-cause mortality and stroke recurrence for patients with first ever stroke (FES). Adult patients with FES were registered during a 24-month period (2010-2012) and followed-up for 12 months. We calculated cumulative incidences of stroke mortality and recurrence. Univariable and multivariable Cox proportional hazards regression analyses were used to identify independent determinants of 1-year mortality and 1-year stroke recurrence. We prospectively documented 703 first ever stroke cases (mean age 75 ± 12 years; 52.8% males; ischemic stroke 80.8%, intracerebral hemorrhage 11.8%, subarachnoid hemorrhage 4.4%, undefined 3.0%) with a total follow-up time of 119,805 person-years. The cumulative incidence rates of mortality of all FES patients at 28 days, 3 months and 1 year were 21.3% (95% CI 18.5-24.5%), 26% (95% CI 22.9-29.4%) and 34.7% (95% CI 31.3-38.3%), respectively. The risk of 1-year mortality was independently (p < 0.05) associated with advancing age, history of hypertension, increased stroke severity on admission, and hemorrhagic FES type. Cumulative 1-year stroke mortality differed according to both index FES type (ischemic vs. hemorrhage; p < 0.001), but also across different ischemic stroke subtypes (p = 0.025). The cumulative incidence rates of recurrent stroke at 28 days, 3 months and 1 year were 2.0% (95% CI 1.2-3.6%), 4.2% (2.8-6.2%) and 6.7% (5.1-8.8%), respectively. Comparable to other population-based surveys, our study reports 1-year mortality and stroke recurrence rates in patients with FES. These findings highlight the need for effective secondary prevention strategies in a border region of southeastern Europe, which exhibits very high FES incidence rates.