Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke: A Prospective Cohort Study.

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.

[Determination of the Association Between Smoking and Recurrence of Ischemic Stroke using a Competing Risks Model].

OBJECTIVE: To determine the association between smoking and ischemic stroke recurrence. METHODS: We conducted a prospective follow-up study of patients with first incidence of stroke. A competing risks model was used to establish the association between smoking and stroke recurrence. RESULTS: A total of 594 stroke patients were recruited. Among the 361 male patients, 59 recurrent events and 13 competing events occurred. Among the 233 female patients (all were non-smokers), 49 recurrent events and 11 competing events occurred. Adjusted for confounding factors, male nonsmokers exposed to passive smoking had a SHR of 3. 040 in comparison with those without exposure to smoking and the P value was borderline significant. Those who smoked 100-200 cigarettes a year had a SHR of 0. 947. The other groups with exposure to smoking had a greater than 1 SHR, but without statistical significance. Moreover, no significant associations between recurrence of ischemic stroke and smoking index/cumulative smoking were found. The female nonsmokers who had exposure to passive smoking only at follow-ups had a SHR of 1. 4 (and all other groups had less than 1 SHR). But no statistical significances were found in the comparisons. CONCLUSION: Further research with a larger sample size is needed to establish the association between smoking and recurrence of ischemic stroke.

[Changes in health-related quality of life in incipient stroke survivors].

OBJECTIVE: To assess the long-term changes in quality of life of stroke patients. METHODS: A total of 467 stroke survivors were recruited for this study. The participants completed the 12-Item Short Form Health Survey (SF-12) at a three-month interval over two years. Multi-level modelling was performed to identify the trend of changes and associated demographic characteristics. RESULTS: The participants had (31.50 +/- 10.49) PCS and (51.92 +/- 10.03) MCS at the baseline survey. Overall, PCS and MCS scores increased over time, but MCS scores declined slightly 15 months later. Men had higher PCS scores than women. The multi-level model revealed similar trends of PCS changes in those with different gender and education. Older patients had slower changes in quality of life over time (beta9 = -0.013, P = 0.03) compared with their younger counterparts. The trends of MCS changes were similar among those with different age, gender and education. CONCLUSION: Support should be strengthened for female stroke survivors and those with older age and lower levels of education.

[Assessing quality of life of patients with stroke using EQ-5D and SF-12].

OBJECTIVE: To compare.the results of EQ-SD and SF-12 for assessing health-related quality of life in stroke patients. METHODS: EQ-5D and SF-12 were administered to 598 ischemic stroke patients through face-to-face interviews. Differences in PCS-12 and MCS-12 scores across different levels of EQ-5D dimensions were tested using analysis of variance (ANOVA). The EQ-5D index and visual analogue scale/score (VAS) scores of respondents were compared between those with higher than and lower than median SF-12 scores using student t-test. Pearson correlations between PCS-12 and EQ-5D scores were tested. RESULTS: PCS-12 and MCA-12 scores varied across different levels of EQ-5D dimensional scores, except for pain/discomfort. EQ-5D and VAS scores varied between those with high and low SF-12 scores. No significant differences in EQ-5D index and VAS scores were found in the EQ-5D indicated healthy respondents between those with high and low SF-12 scores (P>0.05). PCS-12 was positively correlated with EQ-5D index and VAS scores, with r=0.15 (P<0.001) and r=0.33 (P< 0.001), respectively. MCS-12 was also positively correlated with EQ-5D index and VAS score, with r=0.17 (P<0.001) and r = 0.13 (P<0.001), respectively. CONCLUSION: Both instruments are valid measurements for assessing quality of life. The SF-12 appeared to be more sensitive to differences in health status. EQ-5D is preferable if both quality of life assessment and health economics study are to be conducted.