Impact of carotid endarterectomy on medical secondary prevention after a stroke or a transient ischemic attack -: Results from the reduction of atherothrombosis for continued health (REACH) registry
Impact of carotid endarterectomy on medical secondary prevention after a stroke or a transient ischemic attack -: Results from the reduction of atherothrombosis for continued health (REACH) registry
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DOI：
10.1161/01.str.0000249411.44097.5b
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发表时间：
2006-12-01
期刊：
影响因子：
8.3
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Touze, Emmanuel;Mas, Jean-Louis;Bhatt, Deepak L.
背景和目的-颈动脉内膜切除术史是否影响患者对药物治疗的依从性和医生对缺血性卒中或短暂性脑缺血发作（TIA）后治疗的态度尚不清楚。方法-我们研究了国际减少动脉粥样硬化血栓形成持续健康（REACH）的18467例缺血性卒中和TIA患者的基线数据。登记研究动脉内膜切除术的历史对二级医疗预防的影响，通过使用抗血小板药物和他汀类药物，以及控制胆固醇水平，血糖水平和血压. Results-Among有缺血性卒中或TIA病史的患者，有动脉内膜切除术史的患者（n = 1474）更可能接受抗血小板药物和他汀类药物治疗，血压< 140/90 mm Hg，空腹总胆固醇< 200 mg/dL。在糖尿病患者中，动脉内膜切除术与较低的空腹血糖水平相关。在多变量logistic回归分析中，动脉内膜切除术与抗血小板药物的使用显著相关（比值比[OR]，1.6; 95% CI，1.3至1.9; P < 0.0001）和他汀类药物（OR，1.8; 1.6至2.0; P < 0.0001），并且胆固醇水平< 200 mg/dL（OR，1.3; 1.2至1.5; P < 0.0001）。相比之下，与血压和血糖水平的关联不再显着。有没有异质性，在世界各地或专家谁入组patients.Conclusions -颈动脉内膜切除术与较高的使用抗血小板药物和他汀类药物在中风/TIA患者。与血压和血糖控制没有这种联系表明，二级医疗预防质量的个人决定因素因风险因素和药物类别而异。
Background and Purpose - Whether a history of carotid endarterectomy influences patient compliance with medical treatments and physician attitude toward treatments after ischemic stroke or transient ischemic attack (TIA) is not well known.Methods - We studied the baseline data of 18 467 ischemic stroke and TIA patients from the international REduction of Atherothrombosis for Continued Health ( REACH) Registry and investigated the impact of a history of endarterectomy on the secondary medical prevention measured by the use of antiplatelet agents and statins, and by the control of cholesterol level, glucose level, and blood pressure.Results - Among the patients with a history of ischemic stroke or TIA, those with a history of endarterectomy (n = 1474) were more likely to receive antiplatelet agents and statins, to have a blood pressure < 140/90 mm Hg, and a fasting total cholesterol < 200 mg/dL. In diabetic patients, endarterectomy was associated with lower fasting blood glucose levels. In multivariate logistic regression analyses, endarterectomy was significantly associated with the use of antiplatelet agents (odds ratio [OR], 1.6; 95% CI, 1.3 to 1.9; P < 0.0001) and statins (OR, 1.8; 1.6 to 2.0; P < 0.0001), and with a cholesterol level < 200 mg/dL (OR, 1.3; 1.2 to 1.5; P < 0.0001). By contrast, the associations with blood pressure and blood glucose levels were no longer significant. There was no heterogeneity across the world regions or among the specialists who enrolled the patients.Conclusions - Carotid endarterectomy is associated with a higher use of antiplatelet agents and statins in stroke/TIA patients. The absence of such an association with blood pressure and blood glucose control suggests that the individual determinants of the quality of the secondary medical prevention vary from one risk factor to another and from one class of drugs to another.