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Stroke recurrence and mortality in northeastern Greece: the Evros Stroke Registry

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Abstract

Up to date there is no population-based study from Greece providing long-term data on incidence of both all-cause mortality and stroke recurrence for patients with first ever stroke (FES). Adult patients with FES were registered during a 24-month period (2010–2012) and followed-up for 12 months. We calculated cumulative incidences of stroke mortality and recurrence. Univariable and multivariable Cox proportional hazards regression analyses were used to identify independent determinants of 1-year mortality and 1-year stroke recurrence. We prospectively documented 703 first ever stroke cases (mean age 75 ± 12 years; 52.8% males; ischemic stroke 80.8%, intracerebral hemorrhage 11.8%, subarachnoid hemorrhage 4.4%, undefined 3.0%) with a total follow-up time of 119,805 person-years. The cumulative incidence rates of mortality of all FES patients at 28 days, 3 months and 1 year were 21.3% (95% CI 18.5–24.5%), 26% (95% CI 22.9–29.4%) and 34.7% (95% CI 31.3–38.3%), respectively. The risk of 1-year mortality was independently (p < 0.05) associated with advancing age, history of hypertension, increased stroke severity on admission, and hemorrhagic FES type. Cumulative 1-year stroke mortality differed according to both index FES type (ischemic vs. hemorrhage; p < 0.001), but also across different ischemic stroke subtypes (p = 0.025). The cumulative incidence rates of recurrent stroke at 28 days, 3 months and 1 year were 2.0% (95% CI 1.2–3.6%), 4.2% (2.8–6.2%) and 6.7% (5.1–8.8%), respectively. Comparable to other population-based surveys, our study reports 1-year mortality and stroke recurrence rates in patients with FES. These findings highlight the need for effective secondary prevention strategies in a border region of southeastern Europe, which exhibits very high FES incidence rates.

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Authors and Affiliations

  1. Department of Neurology, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Georgios Tsivgoulis, Athanasia Patousi, Aikaterini Terzoudi, Charitomeni Piperidou, Ioannis Heliopoulos & Konstantinos Vadikolias

  2. Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece

    Georgios Tsivgoulis, Aristeidis H. Katsanos, Christina Zompola & Sokratis Triantafyllou

  3. Department of Neurology, School of Medicine, University of Ioannina, Ioannina, Greece

    Aristeidis H. Katsanos

  4. First Department of Internal Medicine, AHEPA University Hospital, Hypertension Excellence Center, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Maria Pikilidou & Pantelis Zebekakis

  5. Department of Neurosurgery, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Theodosis Birbilis

  6. Department of Radiology, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Michael Mantatzis

  7. Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece

    Maria Yavropoulou

  8. Second Department of Internal Medicine, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Nikolaos Papanas & Efstratios Maltezos

  9. First Department of Internal Medicine, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Panagiotis Skendros

  10. Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    George S. Georgiadis

Authors
  1. Georgios Tsivgoulis
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  2. Aristeidis H. Katsanos
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  3. Athanasia Patousi
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  4. Maria Pikilidou
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  5. Theodosis Birbilis
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  6. Michael Mantatzis
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  7. Maria Yavropoulou
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  8. Christina Zompola
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  9. Sokratis Triantafyllou
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  10. Nikolaos Papanas
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  11. Panagiotis Skendros
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  12. Aikaterini Terzoudi
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  13. George S. Georgiadis
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  14. Pantelis Zebekakis
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  15. Efstratios Maltezos
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  16. Charitomeni Piperidou
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  17. Ioannis Heliopoulos
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  18. Konstantinos Vadikolias
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Contributions

Dr. GT: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content. Dr. AHK: analysis and interpretation, critical revision of the manuscript for important intellectual content. Dr. AP: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. MP: analysis and interpretation, critical revision of the manuscript for important intellectual content. Dr. TB: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. MM: critical revision of the manuscript for important intellectual content. Dr. MY: critical revision of the manuscript for important intellectual content. Dr. CZ: critical revision of the manuscript for important intellectual content. Dr. ST: critical revision of the manuscript for important intellectual content. Dr. NP: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. PS: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. AT: acquisition of data, critical revision of the manuscript for important intellectual content. Dr. GSG: critical revision of the manuscript for important intellectual content. Dr. PZ: critical revision of the manuscript for important intellectual content. Dr. EM: critical revision of the manuscript for important intellectual content. Dr. CP: critical revision of the manuscript for important intellectual content. Dr. IH: critical revision of the manuscript for important intellectual content. Dr. KV: critical revision of the manuscript for important intellectual content, study supervision.

Corresponding author

Correspondence to Georgios Tsivgoulis.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Tsivgoulis, G., Katsanos, A.H., Patousi, A. et al. Stroke recurrence and mortality in northeastern Greece: the Evros Stroke Registry. J Neurol 265, 2379–2387 (2018). https://doi.org/10.1007/s00415-018-9005-6

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  • DOI: https://doi.org/10.1007/s00415-018-9005-6

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