***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose Secondary prevention trials do not distinguish outcomes according to stroke cause . The purpose of the study was to determine whether trial efficacy of anticoagulation for secondary prevention could be replicated in clinical practice in strokes of different etiology . Methods A 2-year observation study was undertaken in 288 stroke patients with atrial fibrillation ( mean age 76 years ; 55 % women ) who were receiving anticoagulation therapy to maintain an international normalized ratio of 2.0 to 3.0 . Comparisons were made of ( 1 ) patient characteristics , anticoagulation control , and annual stroke/hemorrhage rates with those of the European Atrial Fibrillation Trial and ( 2 ) cause of recurrent stroke by initial stroke subtype . Results Subjects were 5 years older ( 95 % CI 3 to 7 years ) , and more patients had  small-vessel stroke ( 26 % versus 14 % ; 95 % CI 3 % to 17 % ) compared with corresponding trial data . The duration spent in the target anticoagulation range ( 55 % versus 59 % ) , recurrent stroke rate ( 5.1 % versus 3.6 % per year ) , and major ( 2.3 % versus 2.2 % per year ) or minor ( 9.5 % versus 11.8 % per year ) hemorrhage rates were comparable with those in patients receiving warfarin  in the r and omized study . Ten of 14 ( 71 % ) of embolic recurrences occurred in patients with a previous cardioembolic episode , and 8 of 11 ( 73 % ) lacunar recurrences occurred in patients with previous lacunar stroke as the qualifying event for anticoagulation ( P = 0.025 ) . Only 3 of 14 cardioembolic compared with 8 of 11 lacunar recurrences occurred during adequate anticoagulation . Conclusions Anticoagulation for secondary stroke prevention in clinical practice achieves outcomes comparable with those of r and omized trials . Nearly 26 % of qualifying strokes and 40 % of recurrences were nonembolic ; stroke subtype should be considered when making treatment decisions Few studies have evaluated the factors influencing or predicting long-term survival after stroke in an unselected series of patients in whom the underlying cerebrovascular pathology is clearly defined . Moreover , the relative importance of risk factors for stroke , including sociodemographic and premorbid variables , has not been described in detail . Methods The study cohort consisted of 492 patients with stroke who were registered with a population -based study of acute cerebrovascular disease undertaken in Perth , Western Australia , during an 18-month period in 1989 and 1990 . Objective evidence of the pathological basis of the stroke was obtained in 86 % of cases , and all deaths among patients during a follow-up of 1 year were review ed . Results One hundred twenty patients ( 24 % ) died within 28 days of the onset of stroke . Among the different subtypes of stroke , the 1-year case fatality ( mean , 38 % ) varied from 6 % and 16 % for boundary zone infa rct ion and lacunar infa rct ion , respectively , to 42 % and 46 % for subarachnoid hemorrhage and primary intracerebral hemorrhage , respectively . Using Cox proportional-hazards analysis , a predictive model was developed on 321 patients with acute stroke ( test sample ) . The best model contained five baseline variables that were independent predictors of death within 1 year : coma ( relative risk [ RR ] , 3.0 ; 95 % confidence interval [ CI ] , 1.1 to 8.4 ) , urinary incontinence ( RR , 3.9 ; 95 % CI , 1.4 to 10.6 ) , cardiac failure ( RR , 6.5 ; 95 % CI , 2.8 to 15.1 ) , severe paresis ( RR , 4.9 ; 95 % CI , 1.6 to 15.5 ) , and atrial fibrillation ( RR , 2.0 ; 95 % CI , 1.1 to 3.5 ) . The sensitivity , specificity , and negative predictive value of this model for predicting death were 90 % , 83 % , and 95 % , respectively . When applied to a second r and omly selected validation sample of 171 events , sensitivity was 94 % , specificity 62 % , and negative predictive value 92 % , indicating stability of the model . Conclusions Although the case fatality , timing , and cause of death vary considerably among the different pathological subtypes of stroke , simple clinical measures that reflect the severity of the neurological deficit and associated cardiac disease at onset independently predict death by 1 year and may help to direct management We prospect ively studied stroke recurrence in 1,273 patients with ischemic stroke who were entered into the Stroke Data Bank . Median follow-up was 13 months . The 2-year cumulative recurrence rate among these patients was 14.1 % . Age , sex , race , history of hypertension , atrial fibrillation , or transient ischemic attacks , and stroke location were not associated with a higher risk of stroke recurrence . Patients with an elevated blood pressure , an abnormal initial computed tomogram , or a history of diabetes mellitus were at a higher risk of stroke recurrence . In contrast , patients with an infa rct of unknown cause were at a lower risk of stroke recurrence than patients with a defined stroke mechanism , such as lacune , embolism , or atherosclerosis . A multivariate model suggests that patients at the lowest risk for stroke recurrence have a low diastolic blood pressure , no history of stroke , no history of diabetes mellitus , and an infa rct of unknown cause Background and Purpose — A long-term follow-up study was conducted in patients with lacunar infa rct to assess how 24-hour blood pressure monitoring values and MRI findings , in particular lacunar infa rcts and diffuse white matter lesions , can predict subsequent development of dementia and vascular events , which include cerebrovascular and cardiovascular events . Methods — One hundred seventy-seven patients were tracked for a mean of 8.9 years of follow-up . Documented events comprise the development of dementia and the occurrence of vascular events . The predictors for developing dementia and vascular events were separately evaluated by Cox proportional hazards analysis . Results — Twenty-six patients developed dementia  ( 0.17/100 patient-years ) . Male sex ( relative risk [ RR ] , 4.2 ; 95 % CI , 1.2 to 14.7 ) , cognitive impairment ( RR , 3.0 ; 95 % CI , 1.0 to 8.5 ) , confluent DWML ( moderate : RR , 7.1 ; 95 % CI , 1.6 to 31.5 ; severe : RR , 35.8 ; 95 % CI , 7.2 to 177.3 ) , and nondipping status ( RR , 7.1 ; 95 % CI , 2.2 to 22.0 ) were independent predictors for dementia . Forty-six patients suffered from vascular events ( 3.11/100 patient-years ) . Diabetes mellitus ( RR , 5.7 ; 95 % CI , 2.7 to 11.9 ) , multiple lacunae ( moderate : RR , 6.4 ; 95 % CI , 2.5 to 15.8 ; severe : RR , 8.5 ; 95 % CI , 3.1 to 23.3 ) , and high 24-hour systolic blood pressure ( > 145 mm Hg versus < 130 mm Hg ) ( RR , 10.3 ; 95 % CI , 1.3 to 81.3 ) were independent predictors for vascular events . Conclusions — Predictors for developing dementia and vascular events appear to differ . Male sex , confluent diffuse white matter lesions , and nondipping status were independent predictors for subsequent development of dementia , while diabetes mellitus , multiple lacunae , and high 24-hour systolic blood pressure were independent predictors for vascular events The aim of this article was to study mortality following a first-ever cerebral infa rct , accounting for ischemic stroke subtypes ( lacunar , cardioembolic , atherothrombotic ) and relevant prognostic variables . This study was done from s a hospital-based prospect i ve registry of all patients with a first cerebral infa rct , with a high case ascertainment of first and recurrent stroke by CT .  We used a cross-sectional follow-up , using st and ardized methods . Analyses were performed using crude comparison of mortality data and death causes between stroke subtypes . We analyzed 30-day case fatality and 1-year mortality in 30-day survivors by means of logistic regression analysis , and mortality in 1-year survivors by means of Cox proportional hazard modeling . We also constructed Kaplan-Meier survival curves , and used log-rank testing for differences between stroke subtypes . Thirty-day case fatality was 10 % , 1-year mortality 15 % , and after 1-year mortality 16 % . Mean follow-up was 691 , SD 521 days . At the end of follow-up 36 % of all patients had died . Mortality was at all three time points lowest in lacunar stroke ( 2 , 12 , and 14 % , respectively ) , intermediate in atherothrombotic stroke ( 10 , 16 , and 15 % , respectively ) , and highest in cardioembolic stroke ( 23 , 22 , and 21 % , respectively ) . Death related to recurrent stroke was similar in all three stroke subtypes ( 13 - 16 % ) . Although 30-day case fatality rate was low in lacunar stroke , a quarter of lacunar stroke patients had died at the end of follow-up . Diabetes mellitus , age , stroke subtype , and initial stroke severity were independent predictors of 30-day case fatality , but only diabetes and age were consistent independent predictors for later mortality . Recurrent stroke and heart failure were important death causes . Prognosis for ( future ) death following a first cerebral infa rct differs between stroke subtypes ; lacunar stroke patients have the lowest mortality . However , lacunar stroke can not be regarded as a mild stroke type , as after 2 years more than a quarter of such stroke patients had died . Cardioembolic stroke patients have the grimmest prognosis : more than half of them had died within 1.5 years . Better prognosis for long-term survival following stroke may be achieved by therapies which lower the risk of stroke recurrence , provide better treatment of heart failure , or both Background and Purpose — This article examines stroke recurrence and whether the subtype of the initial stroke influences the risk and subtypes of further strokes . The proportion of recurrences attributable to conventional risk factors is quantified . Methods — From January 1995 to August 2000 , all first-in-a-lifetime strokes ( n=1626 ) were identified and prospect ively followed up in a defined multiethnic inner city population of 234 533 . Twelve overlapping referral sources and face-to-face follow-up at 3 months and 1 and 3 years were used to attain complete registration of stroke recurrence . Index and recurrent stroke were classified according to the Oxford Community Stroke Project classification . Results — In 2744 person-years of follow-up , 153 recurrences were observed . At 5 years , the cumulative risk of first stroke recurrence was 16.6 % ( 95 % CI , 13.5 to 20.4 ) , and the combined risk of death or stroke recurrence was 65.3 % ( 95 % CI , 61.9 to 68.6 ) . Ethnicity and subtype of index stroke were not associated with stroke recurrence . A change in subtype between index and recurrent stroke occurred in 45.5 % ( 95 % CI , 35.8 to 55.2 ) of cases and was most frequent among index lacunar strokes and primary intracerebral hemorrhages . In multivariable analyses , diabetes mellitus and atrial fibrillation were associated with both stroke recurrence and recurrence-free survival . In the stroke population , 9.1 % ( 95 % CI , −2.0 to 20.2 ) of recurrences were attributable to diabetes and 4.9 % ( 95 % CI , −7.3 to 17.2 ) to atrial fibrillation during the first year after the index stroke . Conclusions — The cause of stroke recurrence is multifactorial , and the subtypes of index and recurrent strokes are often not identical . Most recurrences remain unexplained by conventional risk factors BACKGROUND AND PURPOSE Information regarding risk factors for early recurrence is limited . Our aim was to identify the clinical predictors of early recurrence after ischemic stroke . METHODS We prospect ively examined 297 patients ( mean age , 72.0+/-8.4 years ) hospitalized with ischemic stroke to identify recurrent strokes occurring within 90 days of the index stroke .  Survival free of recurrence was estimated using Kaplan-Meier analysis stratified by demographic variables ; vascular risk factors ; stroke syndrome , subtype , vascular territory , and severity ; scores on the Barthel Index and Mini-Mental State Examination during hospitalization ; blood pressure on admission ; and selected laboratory data . We estimated the relative risk ( RR ) of early recurrence associated with those variables using proportional hazards analysis . RESULTS We identified 22 recurrent events in the first 90 days after the index stroke , result ing in an early stroke recurrence rate of 7.4 % , and death occurred immediately after recurrence in 6 of the 22 patients . A major hemispheric stroke syndrome ( RR=2.9 ; 9 
    Output:
    
Recurrent strokes were more likely to be lacunar if the index event was lacunar .
Thus , although early mortality and stroke recurrence risks are higher among non-lacunar than lacunar infa rct patients , the risks appear not to differ in the longer term and the risks of cardiac outcomes are similar , although data are limited .
There is some evidence that recurrent ischaemic stroke subtypes breed true .
These results provide limited support for a distinct arterial pathology underlying lacunar infa rct ion