Objective To investigate the differences in clinical characteristics and outcomes of patients with
ischemic cerebrovascular disease with or without Prior history of stroke in China.
Methods This study was based on the data of the Third China National Stroke Registry (CNSR-
Ⅲ), a national multicenter prospective cohort, which enrolled patients with acute ischemic stroke or
TIA from August 2015 to March 2018. Demographic information, vascular risk factors, five types
of medication history, baseline clinical characteristics, and causative classification system (CCS)
subtypes were collected. Outcomes were followed up within 3 months and 1 year. The outcomes
included recurrent stroke (ischemic or hemorrhagic stroke), composite vascular events (stroke,
myocardial infarction and vascular death), death due to cerebrovascular disease and poor functional
outcome (mRS>2). Patients were divided into two groups according to whether there was prior
stroke, then clinical characteristics and stroke outcomes were compared between the two groups.
The relationship between history of stroke and stroke outcome was also analyzed.
Results A total of 15 166 eligible patients were included, with a mean age of 62.2±11.3 years old
and 4802 females (31.7%), 3355 (22.1%) patients with stroke history and 11 811 (77.9%) without
stroke history. The age, proportion of medical history (coronary heart disease, hypertension,
dyslipidemia, diabetes, atrial fibrillation) and medication history, admission NIHSS, proportion of
hypoglycemic therapy and antihypertensive therapy in the group with stroke history were higher
than those in the group without stroke history, all with statistical differences; the proportion of
smoking and drinking and antiplatelet therapy, and the level of LDL-C at admission in the group
with stroke history were lower than those in the group without stroke history. There was statistical
difference in the distribution of CCS subtypes between the two groups. The proportion of large
atherosclerotic and cardioembolic stroke in CCS subtyping in the group with stroke history was
higher than that in the group without stroke history (P<0.001). Stroke history was a risk factor for
poor functional outcome at 3 months (adjusted OR 1.25, 95%CI 1.09-1.44, P =0.002), and was a
risk factor for stroke recurrence (adjusted HR 1.44, 95%CI 1.25-1.67, P <0.001), composite vascular
events (adjusted HR 1.43, 95%CI 1.24-1.64, P <0.001), death due to cerebrovascular disease
(adjusted HR 1.42, 95%CI 1.12-1.80, P =0.004), and poor functional outcome (adjusted OR 1.63,
95%CI 1.42-1.88, P <0.001) at 1 year.
Conclusions There were significant difference in clinical characteristics and outcomes between
ischemic stroke patients with or without stroke history. Despite stroke secondary prevention,
prior stroke is still a risk factor for stroke recurrence, composite vascular events, death due to
cerebrovascular disease and poor functional outcomes at 1 year.
