Original article Long-term prognosis of Chinese patients with a lacunar infarct associated with small vessel disease: a five-year longitudinal study Vincent C. T. Mok 1à , Alexander Y. L. Lau 1 , Adrian Wong 1 , Wynnie W. M. Lam 2 , Anne Chan 1 , Howan Leung 1 , Edward Wong 1 , Yannie Soo 1 , Thomas Leung 1 , and Lawrence K. S. Wong 1 Rationale Lacunar infarct associated with small vessel dis- ease is a common stroke subtype in China and has a favorable short-term prognosis. Data on its long-term prognosis among Chinese patients are lacking. Aims We aimed to study its long-term prognosis and pre- dictors for poor outcomes. Design We followed up to 75 consecutive Chinese stroke patients who had a lacunar infarct for a period of 5 years. Clinical outcomes with respect to mortality and recurrent stroke were noted. We evaluated baseline clinical and imaging predictors for such outcomes using the Cox regression analysis. Study Outcomes Sixteen (21 . 3%) patients died and 12 (16%) patients had recurrent stroke during follow-up. Twenty-one (28%) patients had combined events of either death and/or recurrent stroke. Univariate Cox regression analysis showed that age, literacy, National Institute of Health Stroke Scale, incident stroke/transient ischemic attack, and white matter lesion volume predicted survival, while, age, National Insti- tute of Health Stroke Scale, systolic blood pressure, hyperho- mocysteinemia, silent lacunes, microbleeds, and white matter lesion volume predicted recurrent stroke. Multivariate Cox regression analysis showed that National Institute of Health Stroke Scale (HR 1 . 25, 95% CI 1 . 05–1 . 48) and white matter lesion volume (HR 1 . 46, 95% CI 1 . 11–1 . 92) predicted combined events of mortality and/or recurrent stroke after age adjust- ment. Conclusion Approximately one in four patients either died and/or had recurrent stroke within 5 years after a lacunar infarct. Age, stroke severity, and volume of white matter lesion predict a poor long-term prognosis. Key words: Chinese, lacunar infarct, long-term prognosis Introduction Stroke remains the leading cause of morbidity and mortality in the world. In China, stroke-related death is predicted to increase from 1Á6 million per year in 2000 to 2Á3 million in 2020 (1). A lacunar infarct associated with small vessel disease (SVD) is one of the most common stroke subtypes among Chinese individuals, accounting for more than 30% of Chinese ischemic stroke patients (2), and has attracted less attention, compared with other stroke subtypes due to its favorable short-term outcomes (2, 3). However, recent studies among Caucasians demonstrated that its long-term prognosis in terms of mortality and recurrent stroke is similar to that of nonlacunar stroke (3, 4). To date, studies on long-term prognosis of a lacunar infarct among Chinese individuals are lacking. In this study, we aimed to investigate the long-term prognosis of Chinese stroke patients with a lacunar infarct associated with SVD and to identify baseline clinical and imaging risk factors that are predictive of a poor outcome. Methods Subjects The recruitment and methods of assessment of the current cohort were described previously in detail (2). In brief, among Correspondence: Dr Vincent C. T. Mok à , Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Adminis- trative Region, China. Tel: 1852-26322195; Fax: 1852-26373852; e-mail: vctmok@cuhk.edu.hk 1 Department of Medicine and Therapeutics, Division of Neurology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China 2 Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China & 2009 The Authors. & 2009 World Stroke Organization International Journal of Stroke Vol 4, April 2009, 81–88 81