Incidence Rate and Factors Predicting the Recurrent Cerebral Ischemic Events After the First-Ever Ischemic Stroke: A Single-Center Exploratory Study From the Eastern Region of Saudi Arabia

Objective: First-ever ischemic stroke (FIS) patients carry a higher risk of recurrent ischemic strokes (RIS). This study reports the incidence rate and describes the factors predicting recurrences in FIS patients.Methods: This retrospective study, enrolling patients with FIS, was carried out at the King Fahd Hospital. Association between different variables and RIS was determined by estimating the 95% confidence intervals (95% CI) and odds ratio (OR).Results: The majority of patients were Saudi (74.1%) and male (72.9%). Over a 5-year follow-up study, the incidence rate was 26.1% (95% confidence interval [CI] = 22.2-30.1) for all recurrences and 22.7% (95% CI = 19.2-26.5) for the first recurrence. Multivariate analysis revealed a strong association between RIS and hypertension (p = 0.002), HbA1c > 7% (p = 0.04), dyslipidemia (p = 0.001), and large-artery atherosclerotic (LAA) subtype (p = 0.04). Diabetes mellitus was not a significant predictor in multivariate analysis (p = 0.15). Most of our patients had multiple vascular risk factors (71.2%). The LAA subtype had the lowest 5-year RIS-free survival (48%), whereas the small vessel occlusive subtype had the highest (83%) according to Kaplan-Meier survival analysis for RIS based on stroke subtypes.Conclusion: This research involving patients with FIS determined that the incidence rate for RIS is comparable to what has been reported in existing literature. Hypertension, dyslipidemia, inadequately managed chronic glycaemia, and the LAA subtype were identified as independent predictors for RIS, and their significant prevalence highlights the necessity of implementing preventive measures.