Open Access Research article

Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort

Alessandra C Goulart15*, Tiotrefis G Fernandes2, Itamar S Santos1, Airlane P Alencar3, Isabela M Bensenor14 and Paulo A Lotufo14

Author Affiliations

1 Hospital Universitário, University of São Paulo, São Paulo, Brazil

2 University Federal of Amazonas, Coari, Amazonas, Brazil

3 Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil

4 School of Medicine, University of São Paulo, São Paulo, Brazil

5 Center for Clinical and Epidemiological Research, Hospital Universitario, Av. Prof Lineu Prestes 2565, Cidade Universitária, Butantan, São Paulo CEP 0550800-900, Brazil

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BMC Neurology 2013, 13:51  doi:10.1186/1471-2377-13-51

Published: 24 May 2013



Few studies have examined both ischemic and hemorrhagic stroke to identify prognostic factors associated to long-term stroke survival. We investigated long-term survival and predictors that could adversely influence ischemic and hemorrhagic first-ever stroke prognosis.


We prospectively ascertained 665 consecutive first-ever ischemic and hemorrhagic stroke cases from “The Study of Stroke Mortality and Morbidity” (The EMMA Study) in a community hospital in São Paulo, Brazil. We evaluated cardiovascular risk factors and sociodemographic characteristics (age, gender, race and educational level).


We found a lower survival rate among hemorrhagic cases compared to ischemic stroke cases at the end of 4 years of follow-up (52% vs. 44%, p = 0.04). The risk of death was two times higher among people with ischemic stroke without formal education. Also, we found consistently higher risk of death for diabetics with ischemic stroke (HR = 1.45; 95% CI = 1.07-1.97) compared to no diabetics. As expected, age equally influenced on the high risk of poor survival, regardless of stroke subtype.


For ischemic stroke, the lack of formal education and diabetes were significant independent predictors of poor long-term survival.

Stroke; Registry; Long-term predictors; Survival