Abstract: 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.

Key words: Ischemic stroke; History of stroke; Stroke outcome; Stroke recurrence; Stroke risk factor

摘要： 目的 探讨中国人群中首发和复发缺血性脑血管病患者的临床特征和卒中结局差异。 方法 本研究基于全国多中心前瞻性中国国家卒中登记研究Ⅲ（the third China national stroke regi stry，CNSR-Ⅲ），连续纳入2015年8月-2018年3月急性缺血性卒中或TIA患者，收集人口学信息、血 管危险因素、既往用药史及病因分型系统（causative classification system，CCS）等临床资料，记录随 访3个月和1年时卒中结局。卒中结局包括卒中复发（缺血性卒中或出血性卒中）、联合血管事件（卒中、 心肌梗死及血管性死亡事件）、脑血管病源性死亡及不良功能结局（mRS＞2分）。依据患者既往是否 有卒中病史分为有卒中病史组和无卒中病史组，比较两组的临床特征及卒中结局差异，并分析卒中病 史与卒中结局间的关系。 结果 最终纳入15 166例患者，平均年龄62.2±11.3岁，其中女性4802例（31.7%）；有卒中病史患者 3355例，无卒中病史患者11 811例。有卒中病史组患者年龄，冠心病、高血压、脂代谢紊乱、糖尿病、心 房颤动比例，既往用药史比例、入院NIHSS评分、住院期间降糖和降压治疗比例均高于无卒中病史组， 目前吸烟和重度饮酒比例、入院时LDL-C水平及住院期间抗血小板治疗比例低于无卒中病史组，差 异均有统计学意义。两组CCS分型的分布差异有统计学意义，其中有卒中病史组大动脉粥样硬化型和 心源性栓塞型卒中比例高于无卒中病史组。多因素分析结果显示，卒中病史是随访3个月不良功能结 局（校正OR 1.25，95%CI 1.09～1.44，P =0.002），随访1年卒中复发（校正HR 1.44，95%CI 1.25～1.67， P＜0.001）、联合血管事件（校正HR 1.43，95%CI 1.24～1.64，P＜0.001）、脑血管病源性死亡（校正 HR 1.42，95%CI 1.12～1.80，P =0.004）、不良功能结局（校正OR 1.63，95%CI 1.42～1.88，P＜0.001）的 危险因素。 结论 有无卒中病史的缺血性卒中患者的临床特征及随访结局差异较大，尽管患者进行卒中二级 预防治疗，卒中病史仍然是患者1年卒中复发、联合血管事件、脑血管病源性死亡及不良功能结局的 危险因素。

关键词: 缺血性卒中; 卒中病史; 卒中结局; 卒中复发; 卒中危险因素