Five-year recurrence rate following stroke in the Mashhad Stroke Incidence Study: A population-based study of stroke in the Middle East (P6.276)

Objective: To identify the long-term recurrence rate and associated factors, using a population-based stroke registry in Mashhad, a large city in Iran. Background: Even in high income countries where better acute management of stroke has reduced stroke case-fatality, the relatively larger number of stroke survivors can lead to a greater number of people with recurrent stroke, with devastating consequences. Design/Methods: We included 684 patients, 624 with first ever stroke (FES), from the residents of three health districts in Mashhad, Iran from 2006–2007. Patients were followed up at 30 days, 12 months, and 5 years after the index event. Kaplan-Meier analysis was used to determine the cumulative risk of first recurrence. Prognostic variables associated with stroke recurrence were assessed using Cox proportional hazard, backward logistic regression analysis. Results: By the end of 5 years of follow up the cumulative risk of recurrence was 22.2% in FES and 32% in those with history of previous stroke. In univariable Cox proportional hazards analyses older age, the severity of stroke at time of admission, and a history of atrial fibrillation were associated with an increased 5-year risk of recurrence; however, only older age (HR: 1.02; 95% CI: 1.01 to 1.04) was independently associated with a 5-year recurrence. Among FES the long-term risk of recurrence was significantly greater in those with large artery disease (35.6%) and cardioembolism (35.5%) than in those with other stroke subtypes. The greatest cumulative risk of recurrence in FES was observed in the first year after initial stroke, particularly in those with cardioembolic stroke. Conclusions: Almost one in five people with FES had a stroke recurrence during five years. Although advanced age was the only factor that was significantly associated with the risk of recurrent stroke, other unmeasured factors, such as comorbidities, may be contributing to this risk of recurrence. Disclosure: Dr. Amiri has nothing to disclose. Dr. Salehi has nothing to disclose. Dr. Azarpazhooh has nothing to disclose. Dr. G. Thrift has nothing to disclose. Dr. Kapral has nothing to disclose. Dr. Sposato has received personal compensation for activities with Boehringer Ingelheim as a speaker. Dr. Sposato has received research support from Boehringer Ingelheim. Dr. Shoeibi has nothing to disclose. Dr. Hashemi has nothing to disclose. Dr. Farzadfard has nothing to disclose.