Underestimation of the early risk of recurrent stroke - Evidence of the need for a standard definition
Underestimation of the early risk of recurrent stroke - Evidence of the need for a standard definition
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DOI：
10.1161/01.str.0000133129.58126.67
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发表时间：
2004-08-01
期刊：
影响因子：
8.3
通讯作者：
Rothwell, PM
中科院分区：
文献类型：
--
作者：
Coull, AJ;Rothwell, PM
背景-复发性中风的定义有相当大的差异。大多数流行病学研究排除了前28天内的事件（例如，监测心血管疾病的趋势和决定因素[MONICA]）或21天内与出现事件相同地区的事件（例如，大多数卒中发生率研究）。然而，复发在早期最为常见，这些限制性定义可能低估了早期预防的益处。方法：我们在2个人群为基础的队列（牛津血管研究[OXVASC]和牛津郡社区卒中项目[OCSP]）中确定了缺血性卒中发生后90天的复发风险，并采用了3种最常见的定义：在事件发生后超过或等于24小时的任何卒中，不包括非卒中引起的早期恶化（定义a）；如上所述，但不包括在与事故事件相同的领土内21天内发生的任何中风（定义B）；以及任何中风大于或等于事件发生后28天（定义C）。结果：657例患者在事件发生后24小时至90天内有93例复发性卒中。使用定义A的90天复发风险（95% CI）在OCSP中为14.5%(11.5 - 17.5)，在OXVASC中为18.3%（10.8 - 25.8）。使用定义B和C的等效风险在OCSP中分别为8.3%（5.9至10.8）和4.8%(2.8至6.7)，在OXVASC中分别为7.0%（1.6至12.4）和5.9%（1.0至10.9）。部分前循环卒中（22.9%,17.5 ~ 28.2）和后循环卒中（19.5%,13.0 ~ 25.9）复发风险特别高。结论：3种最广泛使用的卒中复发定义产生了明显不同的90天风险。我们建议，在可能的情况下，采用定义A作为标准，以避免低估风险，并允许对不同的研究进行有效的比较。
Background - There is considerable variation in the definitions used for recurrent stroke. Most epidemiological studies exclude events within the first 28 days (eg, Monitoring Trends and Determinants in Cardiovascular Disease [MONICA]) or events within 21 days in the same territory as the presenting event ( eg, most stroke incidence studies). However, recurrence is most common during this early period and these restrictive definitions could underestimate the benefits of early prevention.Methods - We determined the 90-day risk of recurrence after incident ischemic stroke in 2 population-based cohorts ( Oxford Vascular Study [OXVASC] and Oxfordshire Community Stroke Project [OCSP]) with the 3 most common definitions: any stroke greater than or equal to24 hours after the incident event excluding early deterioration not caused by a stroke ( definition A); as above, but excluding any stroke within 21 days in the same territory as the incident event ( definition B); and any stroke greater than or equal to28 days after the incident event ( definition C).Results - 657 patients had 93 recurrent strokes between 24 hours and 90 days after the incident event. The 90-day recurrence risks (95% CI) using definition A were 14.5% (11.5 to 17.5) in the OCSP and 18.3% (10.8 to 25.8) in the OXVASC. The equivalent risks using definitions B and C were 8.3% (5.9 to 10.8) and 4.8% (2.8 to 6.7), respectively, in the OCSP and 7.0% (1.6 to 12.4) and 5.9% (1.0 to 10.9) in the OXVASC. The definition A risk of recurrence was particularly high after partial anterior (22.9%, 17.5 to 28.2) and posterior (19.5%, 13.0 to 25.9) circulation strokes.Conclusions - The 3 most widely used definitions of recurrent stroke yield markedly different 90-day risks. We suggest that, where possible, definition A be adopted as the standard to avoid underestimation of risk and to allow valid comparison of different studies.