Major cardiovascular events and all-cause mortality after ischemic stroke in central Norway – A three-year prospective multicenter study

BACKGROUND: A substantial decline in the incidence of stroke and ischemic heart disease during the last decade is probably due to improved preventive treatment and a reduction in cardiovascular risk factors. Updated estimates on long-term outcomes following first-ever ischemic stroke are therefore limited. PURPOSE: To assess the incidence of major cardiovascular events and all-cause mortality three years post-stroke, and to evaluate the impact of modifiable cardiovascular and other prognostic factors. METHODS: MIDNOR STROKE is a multicenter prospective study including patients with first-ever ischemic stroke admitted to stroke units in Central Norway during 2015-2017. Data were collected during the hospital stay. Information on major cardiovascular events and survival three years post-stroke was retrieved from national medical registries. Competing risk models were used to analyze cardiovascular events. All-cause mortality was analyzed by using Kaplan-Meier and Cox regression. RESULTS: Among 787 included participants, the cumulative incidence of major cardiovascular events was 15.0 % (95 % CI: 12.0-17.0 %), with recurrent stroke as the most common event. The all-cause mortality rate was 18.0 % (95 % CI: 15.0-20.0 %). Coronary artery disease was associated with a higher risk of major vascular events HR: 1.59, 95 % CI: 1.06, 2.38) and all-cause death (HR: 1.66, 95 % CI: 1,11, 2.50). NIHSS at day 1 predicted all-cause mortality (HR: 1.08, 95 % CI: 1.05, 1.10). CONCLUSION: Three-year survival rates post-stroke were higher compared to previous reports; however, the risk of major cardiovascular events remains substantial, affecting 15 % of stroke survivors within three years. Reducing cardiac disease risk and interventions aimed at minimizing stroke severity may improve long-term stroke outcomes.