Relationship of functional disability after a recent stroke with recurrent stroke risk

Background and purpose Post‐stroke disability status is primarily focused on recovery prognostication but the influence of post‐stroke disability on future vascular risk is unknown. The relationship between functional disability after an index stroke and risk of recurrent vascular events was examined. Methods A cohort analysis of 3680 recent non‐cardioembolic, non‐to‐moderate disabled [modified Rankin Scale (mRS) ≤3] stroke patients aged ≥35 years and followed for 2 years was reviewed. The mRS measured at a median of 35 days after the index stroke was analyzed as a dichotomous variable (mRS 3 vs. ≤2) and in a stepwise manner. Independent associations of post‐stroke disability by mRS score with ischaemic stroke (primary outcome), stroke/coronary heart disease/vascular death as major vascular events (secondary outcome) and all‐cause death (tertiary outcome) were analyzed. Results Amongst study participants, 435 (11.8%) had an mRS of 3. Compared with mRS ≤2 as no/slight disability, mRS 3 as moderate disability was associated with a higher risk of stroke (adjusted hazard ratio 1.45, 95% confidence interval 1.06–1.99). Compared with mRS 0, there was a progressively higher independent risk for each of the study outcomes: stroke, mRS 1 (1.42, 0.97–2.08), mRS 2 (1.46, 0.97–2.20), mRS 3 (1.89, 1.20–2.97); major vascular events, mRS 1 (1.31, 1.01–1.70), mRS 2 (1.31, 0.99–1.74), mRS 3 (1.46, 1.06–2.01); and all‐cause death, mRS 1 (1.75, 1.03–2.98), mRS 2 (2.49, 1.44–4.31), mRS 3 (2.72, 1.43–5.19). Conclusion Compared with no/slight disability, moderate disability after a recent stroke is linked to a higher risk of recurrent stroke.