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 morc 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 ecurrence 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.
Continued smoking following stroke is associated with adverse outcomes including increased risk of mortality and secondary stroke. The aim of this study was to examine the long-term trends in smoking behaviors and factors associated with smoking relapse among men who survived their first-ever stroke. Data collection for this longitudinal study was conducted at baseline through face-toface interviews and follow-up was completed every 3 months via telephone, beginning in 2010 and continuing through 2014. Cox proportional hazard regression models were used to identify predictors of smoking relapse behavior. At baseline, 372 male patients were recruited into the study. Totally, 155(41.7%) of these patients stopped smoking for stroke, and 61(39.3%) began smoking again within 57 months after discharge with an increasing trend in the number of cigarettes smoked per day. Exposure to environmental tobacco smoke at places outside of home and work(such as bars, restaurants)(HR, 2.34; 95% CI, 1.04–5.29, P=0.04), not having a spouse(HR, 0.12; 95% CI, 0.04–0.36; P=0.0002) and smoking at least 20 cigarettes per day before stroke(HR, 2.42; 95% CI, 1.14–5.14, P=0.02) were predictors of smoking relapse. It was concluded that environmental tobacco smoke is an important determinant of smoking relapse among men who survive their first stroke. Environmental tobacco smoke should be addressed by smoke-free policies in public places.
