Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack.
Imaging Parameters and Recurrent Cerebrovascular Events in Patients With Minor Stroke or Transient Ischemic Attack.
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DOI：
10.1001/jamaneurol.2015.4906
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发表时间：
2016-05-01
期刊：
影响因子：
29
通讯作者：
Willey, Joshua Z.
中科院分区：
文献类型：
--
作者：
Yaghi, Shadi;Rostanski, Sara K.;Boehme, Amelia K.;Martin-Schild, Sheryl;Samai, Alyana;Silver, Brian;Blum, Christina A.;Jayaraman, Mahesh V.;Siket, Matthew S.;Khan, Muhib;Furie, Karen L.;Elkind, Mitchell S. V.;Marshall, Randolph S.;Willey, Joshua Z.
神经功能恶化和复发性卒中是导致短暂性脑缺血发作和卒中（TIA-S）相关发病率的主要原因。确定TIA-S和国立卫生研究院卒中量表评分为0 - 3分的患者中早期复发性脑血管事件（RCVEs）的预测因子。2010年1月1日至2014年12月31日期间，在2个三级护理中心（哥伦比亚大学医学中心，纽约，纽约和杜兰大学医学中心，新奥尔良，路易斯安那州）进行了一项回顾性队列研究。所有神经科医生诊断的TIA-S患者，美国国立卫生研究院卒中量表评分为0 - 3分，并在急诊科就诊。主要结局（由3名血管神经科医生裁定）为RCVE：住院期间无医学解释的神经功能恶化或复发性TIA-S。在总共1258例患者中，1187例无RCVE，71例有RCVE;在该组中，分别有750例患者（63.2%）和39例患者（54.9%）年龄≥ 60岁。哥伦比亚大学有505例TIA-S患者; 31例（6.1%）发生RCVE（15例患者仅神经功能恶化，11例仅复发TIA-S，5例两者兼有）。杜兰大学的验证队列包括753名患者; 40名（5.3%）患有RCVE（24名患者仅神经功能恶化，16名患者两者兼而有之）。在两个队列的多变量模型中，RCVE的预测因素是神经影像学上的梗死（计算机断层扫描或磁共振成像上的弥散加权成像序列）（哥伦比亚大学：不适用，杜兰大学：比值比，1.75; 95% CI，0.82-3.74; P = 0.15）和大血管疾病病因（哥伦比亚大学：优势比，6.69; 95% CI，3.10-14.50;杜兰大学：优势比，8.13; 95% CI，3.86-17.12; P <0.001）。当两个预测因子同时存在时，发生RCVE的患者百分比增加。当两个预测因子都不存在时，RCVE的发生率极低（高达2%）。在两个队列中，发生RCVE的患者出院回家的可能性较小。在2个独立数据集中，轻度卒中患者的血管成像和可能的神经成像参数（而非临床评分）与RCVE相关。需要前瞻性研究来验证这些预测因素。
Neurological worsening and recurrent stroke contribute substantially to morbidity associated with transient ischemic attacks and strokes (TIA-S). To determine predictors of early recurrent cerebrovascular events (RCVEs) among patients with TIA-S and National Institutes of Health Stroke Scale scores of 0 to 3. A retrospective cohort study was conducted at 2 tertiary care centers (Columbia University Medical Center, New York, New York, and Tulane University Medical Center, New Orleans, Louisiana) between January 1, 2010, and December 31, 2014. All patients with neurologist-diagnosed TIA-S with a National Institutes of Health Stroke Scale score of 0 to 3 who presented to the emergency department were included. The primary outcome (adjudicated by 3 vascular neurologists) was RCVE: neurological deterioration in the absence of a medical explanation or recurrent TIA-S during hospitalization. Of the 1258 total patients, 1187 had no RCVEs and 71 had RCVEs; of this group, 750 patients (63.2%) and 39 patients (54.9%), respectively, were aged 60 years or older. There were 505 patients with TIA-S at Columbia University; 31 (6.1%) had RCVEs (15 patients had neurological deterioration only, 11 had recurrent TIA-S only, and 5 had both). The validation cohort at Tulane University consisted of 753 patients; 40 (5.3%) had RCVEs (24 patients had neurological deterioration only and 16 had both). Predictors of RCVE in multivariate models in both cohorts were infarct on neuroimaging (computed tomographic scan or diffusion-weighted imaging sequences on magnetic resonance imaging) (Columbia University: not applicable and Tulane University: odds ratio, 1.75; 95% CI, 0.82–3.74; P = .15) and large-vessel disease etiology (Columbia University: odds ratio, 6.69; 95% CI, 3.10–14.50 and Tulane University: odds ratio, 8.13; 95% CI, 3.86–17.12; P < .001). There was an increase in the percentage of patients with RCVEs when both predictors were present. When neither predictor was present, the rate of RCVE was extremely low (up to 2%). Patients with RCVEs were less likely to be discharged home in both cohorts. In patients with minor stroke, vessel imaging and perhaps neuroimaging parameters, but not clinical scores, were associated with RCVEs in 2 independent data sets. Prospective studies are needed to validate these predictors.
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