Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Co
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Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study* Pei-jing YAN1†, Li-sha HOU1, 2†, Mi-er LI1, Zhen-xing LU3, Feng-yu ZHAN1, Meng-dong RAN1, Ji-jie LI4, Lu ZHANG1, Rong YANG5, Mu-ke ZHOU5#, Cai-rong ZHU1# 1 Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610044, China 2 National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610044, China 3 The First Clinical College of Lanzhou University, Lanzhou 730000, China 4 Department of Medical Record, West China Second University School, Chengdu 610044, China 5 Department of Neurology, West China Hospital of Sichuan University, Chengdu 610044, China Huazhong University of Science and Technology 2020
Summary: Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence. However, the relationship between lesion locations and stroke recurrence is unclear. We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015. Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers. Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures. Flexible parametric survival models using the proportional hazards scale (PH model) were used to analyze the time-to-event data. Among 633 survivors, 63.51% (n=402) had anterior circulation ischemia (ACI), and more than half of all ACIs occurred in the subcortex. After a median follow-up of 2.5 years, 117 (18.48%) survivors developed a recurrent stroke. The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions (HR, 2.79; 95%CI, 1.53, 5.08; P=0.001). There was no increase in risk among survivors with left-side lesions (HR, 0.97; 95%CI, 0.53, 1.75; P=0.914) or both-side lesions (HR, 1.24; 95%CI, 0.75, 2.07; P=0.401) compared to those with right-side lesions. Additionally, there were no associations between stroke recurrence and lesion locations that were classified based on vascular territory and brain anatomical structures. It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion, although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures. Key words: ischemic stroke; lesion location; prevention; recurrence; flexible parametric survival models; survival analysis
Stroke is the second leading cause of death[1] and the third leading cause of disability adjusting life years worldwide[2], and is the
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