Background and Purpose:With recent advances in secondary prevention management, stroke recurrence rates may have changed substantially. We aim to estimate risks and trends of stroke recurrence over the past 2 decades in a population-based cohort of patients with stroke.Methods:Patients with a first-ever stroke between 1995 and 2018 in South London, United Kingdom (n=6052) were collected and analyzed. Rates of recurrent stroke with 95% CIs were stratified by 5-year period of index stroke and etiologic TOAST (Trial of ORG 10172 in Acute Stroke Treatment) subtype. Cumulative incidences were estimated and multivariate Cox models applied to examine associations of recurrence and recurrence-free survival.Results:The rate of stroke recurrence at 5 years reduced from 18% (95% CI, 15%–21%) in those who had their stroke in 1995 to 1999 to 12% (10%–15%) in 2000 to 2005, and no improvement since. Recurrence-free survival has improved (35%, 1995–1999; 67%, 2010–2015). Risk of recurrence or death is lowest for small-vessel occlusion strokes and other ischemic causes (36% and 27% at 5 years, respectively). For cardioembolic and hemorrhagic index strokes around half of first recurrences are of the same type (54% and 51%, respectively). Over the whole study period a 54% increased risk of recurrence was observed among those who had atrial fibrillation before the index stroke (hazard ratio, 1.54 [1.09–2.17]).Conclusions:The rate of recurrence reduced until mid-2000s but has not changed over the last decade. The majority of cardioembolic or hemorrhagic strokes that have a recurrence are stroke of the same type indicating that the implementation of effective preventive strategies is still suboptimal in these stroke subtypes.

中文翻译：

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脑卒中复发的风险和二级预防：一项基于人群的队列研究。

背景与目的：随着二级预防管理的最新进展，中风复发率可能已发生重大变化。我们的目标是评估以人群为基础的中风患者队列在过去20年中的中风复发风险和趋势。方法：1995年至2018年间在英国南伦敦（n = 6052）发生首次中风的患者收集并分析。95％CIs的复发性卒中发生率按索引卒中和病因TOAST（在急性卒中治疗中ORG 10172试验）的5年期进行分层。估计累积发生率，并应用多变量Cox模型检查复发与无复发生存的相关性。结果：5年后中风复发率从18％（95％CI，1995年至1999年中风的人中有15％–21％）到2000年至2005年中的12％（10％–15％），此后没有改善。无复发生存率有所提高（1995-1999年为35％； 2010-2015年为67％）。对于小血管闭塞性中风和其他缺血性原因，复发或死亡的风险最低（5年时分别为36％和27％）。对于心脏栓塞和出血指数性卒中，约有一半的首次复发属于同一类型（分别为54％和51％）。在整个研究期间，观察到卒中前发生房颤的患者复发风险增加了54％（危险比，1.54 [1.09-2.17]）。结论：直到2000年代中期，复发率一直降低，但直到2000年代中期仍没有在过去十年中发生了变化。