The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study

Abstract

Introduction Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18–50, who visited our hospital (1980–2010). Outcomes assessed at follow-up (2014–2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan–Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4–51.5) for any ischaemic event, 30.1% (95%CI: 24.8–35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1–33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04–1.74), poor kidney function (HR 2.10, 95%CI: 1.32–3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08–3.76) and cardiac disease (HR 1.84, 95%CI: 1.06–3.18) (C-statistic 0.59 (95%CI: 0.55–0.64)). Discussion and conclusion Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.