White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke

Wi Sun Ryu, Dawid Schellingerhout, Keun Sik Hong, Sang Wuk Jeong, Min Uk Jang, Man Seok Park, Kang Ho Choi, Joon Tae Kim, Beom Joon Kim, Jun Lee, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Soo Joo Lee, Jae Guk Kim, Yong Jin Cho, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jong Moo ParkKyusik Kang, Kyung Bok Lee, Tai Hwan Park, Sang Soon Park, Juneyoung Lee, Hee Joon Bae, Dong Eog Kim

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Abstract

ObjectiveTo define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.MethodsA total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.ResultsOverall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.ConclusionsThere is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.

Original languageEnglish
Pages (from-to)E578-E589
JournalNeurology
Volume93
Issue number6
DOIs
Publication statusPublished - 2019 Aug 6

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ASJC Scopus subject areas

  • Clinical Neurology

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Ryu, W. S., Schellingerhout, D., Hong, K. S., Jeong, S. W., Jang, M. U., Park, M. S., Choi, K. H., Kim, J. T., Kim, B. J., Lee, J., Cha, J. K., Kim, D. H., Nah, H. W., Lee, S. J., Kim, J. G., Cho, Y. J., Lee, B. C., Yu, K. H., Oh, M. S., ... Kim, D. E. (2019). White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke. Neurology, 93(6), E578-E589. https://doi.org/10.1212/WNL.0000000000007896