Prestroke antiplatelet therapy and early prognosis in stroke patients: the Dijon Stroke Registry
Prestroke antiplatelet therapy and early prognosis in stroke patients: the Dijon Stroke Registry
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DOI：
10.1111/ene.12060
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发表时间：
2013-06-01
影响因子：
5.1
通讯作者：
Giroud, M.
中科院分区：
文献类型：
--
作者：
Bejot, Y.;Aboa-Eboule, C.;Giroud, M.
背景和目的 既往心血管预防中的抗血小板治疗（APT）在首次卒中患者中很常见。我们的目的是评估 APT 对卒中患者早期结局的预后价值。方法 1985 年至 2011 年期间所有首次中风均来自法国第戎基于人群的中风登记处。记录人口统计学特征、危险因素、中风前治疗和临床信息。进行多变量分析以评估入院前 APT 与出院时严重障碍以及 1 个月和 1 年死亡率之间的关联。结果 4275 例患者中，870 例（20.4%）既往接受过 APT 治疗。 233 名（26.8%）APT 用户和 974 名（28.7%）非用户在出院时出现严重障碍。中风前使用 APT 与出院时严重残疾的几率较低相关[调整后的比值比 (OR)：0.79； 95%置信区间（CI）：0631.00； P=0.046]，1 个月时生存率无显着改善[调整后的风险比 (HR)：0.87； 95%置信区间：0.701.09； P=0.222]，对 1 年死亡率没有影响（HR：0.94；95% CI 0.801.10；P=0.429）。在分层特异性分析中，APT 与心源性缺血性卒中患者 1 个月死亡率风险降低相关（HR：0.65；95% CI：0.430.98；P=0.040）。结论 卒中前 APT 与出院时较轻的障碍相关，除心源性卒中患者外，对 1 个月死亡率没有显着的保护作用。没有观察到 APT 对 1 年死亡率的保护作用。需要进一步的研究来了解先前 APT 在缺血性中风亚型中观察到的不同影响的机制。
Background and purpose Previous antiplatelet therapy (APT) in cardiovascular prevention is common in patients with first-ever stroke. We aimed to evaluate the prognostic value of APT on early outcome in stroke patients. Methods All first-ever strokes from 1985 to 2011 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, prestroke treatments and clinical information were recorded. Multivariate analyses were performed to evaluate the associations between pre-admission APT and both severe handicap at discharge, and mortality at 1month and 1year. Results Among the 4275 patients, 870 (20.4%) were previously treated with APT. Severe handicap at discharge was noted in 233 (26.8%) APT users and in 974 (28.7%) non-users. Prestroke APT use was associated with lower odds of severe handicap at discharge [adjusted odds ratio (OR): 0.79; 95% confidence interval (CI): 0631.00; P=0.046], non-significant better survival at 1month [adjusted hazard ratio (HR): 0.87; 95% CI: 0.701.09; P=0.222] and no effect on 1-year mortality (HR: 0.94; 95% CI 0.801.10; P=0.429). In stratum-specific analyses, APT was associated with a lower risk of 1-month mortality in patients with cardioembolic ischaemic stroke (HR: 0.65; 95% CI: 0.430.98; P=0.040). Conclusions APT before stroke was associated with less severe handicap at discharge, with no significant protective effect for mortality at 1month except in patients with cardioembolic stroke. No protective effect of APT was observed for mortality at 1year. Further studies are needed to understand the mechanisms underlying the distinct effects of prior APT observed across the ischaemic stroke subtypes.