10-year survival after minor stroke established


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People who have had a minor stroke have a 43% chance of another stroke or vascular event within 10-years, suggests a study in this week's issue of THE LANCET.

Although worldwide fatality rates from cerebrovascular disease have fallen, stroke remains one of the most serious neurological problems, and leaves many patients with a chronic disability. Secondary stroke prevention is standard practice in patients with a transient ischaemic attack (TIA) or minor ischaemic stroke, but many of these individuals have a recurrent stroke or other vascular complications.

Ale Algra (University Medical Centre, Utrecht, Netherlands) and colleagues assessed the survival status and occurrence of vascular events in over 2,400 patients recruited from 24 hospitals in the Netherlands. They found that, roughly 10 years after a presentation of TIA or minor ischaemic stroke, about 60% of patients had died and 54% had experienced at least one new vascular event. Event-free survival after 10 years was 48%. The risk of a vascular event was highest shortly after the ischaemic event, reached its lowest point at about 3 years, and gradually rose afterwards.

Professor Algra concludes: "Throughout our study, the risk of mortality gradually rose, whereas that of stroke fell in the first three years and remained constant thereafter…These findings imply that further improvement can still be established on longterm secondary prevention of vascular disease in patients with cerebral ischaemia." (Quote by e-mail; does not appear in published paper)

In an accompanying comment Graeme Hankey (Royal Perth Hospital, Australia) states: "The implications of van Wijk and colleagues' study, which can confidently be generalised to other hospital-referred patients, are that patients with TIA and minor ischaemic stroke should be repeatedly assessed (because their risk can change), treated to prevent cerebrovascular and cardiovascular events, and treated long-term."

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