Long-Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta-Analysis.
Long-Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta-Analysis.
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DOI：
10.1161/jaha.117.007267
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发表时间：
2018-01-18
影响因子：
5.4
通讯作者：
Touzé E
中科院分区：
文献类型：
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作者：
Boulanger M;Béjot Y;Rothwell PM;Touzé E
目前对于缺血性中风或短暂性脑缺血发作后心肌梗死(MI)的风险仍存在不确定性。我们对缺血性中风/短暂性脑缺血发作患者进行了一项系统回顾，以评估与复发性卒中相比，心肌梗死的长期风险。使用随机效应荟萃分析估计心肌梗死和再发卒中的年风险和95%可信区间(95%CI)。我们使用类似的分析计算了致命性和非致命性事件的MI/再发卒中的发生率。有潜在危险因素的患者与没有潜在危险因素的患者相比，使用泊松回归计算心肌梗死的比率。共纳入58项研究(131-299名患者)，平均(范围)随访3.5年(1.0-10.0)年。心肌梗死的风险为1.67%/年(95%可信区间为1.36-1.98，P<0.001)，并且随着时间的推移而降低(Pint=0.021)；研究间的异质性的96%由研究设计、研究周期、随访时间、平均年龄、接受抗血栓治疗的患者比例以及事件与合并的缺血性中风/短暂性脑缺血发作相解释。再发卒中的危险性为4.26%/年(95%可信区间为3.43~5.09，P<0.001)，随时间变化无统计学意义(P>0.05)。发生致死性心肌梗死的风险是卒中复发致死风险的一半(发生率比=0.51，95%可信区间0.14~0.89，P<0.05)。非致死性心肌梗死的危险性比再发非致死性卒中的危险性低75%(发生率比=0.25，95%可信区间0.02~0.50，P<0.05)。男性、高血压、冠状动脉和外周动脉疾病与心肌梗死的风险增加一倍。在缺血性中风/短暂性脑缺血发作后，心肌梗死的风险目前为2%/年，再发中风是比心肌梗死更常见的死亡原因。
Uncertainties remain about the current risk of myocardial infarction (MI) after ischemic stroke or transient ischemic attack. We undertook a systematic review to estimate the long‐term risk of MI, compared to recurrent stroke, with temporal trends in ischemic stroke/transient ischemic attack patients. Annual risks and 95% confidence intervals (95% CI) of MI and recurrent stroke were estimated using random‐effect meta‐analyses. We calculated incidence ratios of MI/recurrent stroke, for fatal and nonfatal events, using similar analyses. Rate ratios for MI in patients with potential risk factors compared to those without were calculated using Poisson regression. A total of 58 studies (131 299 patients) with a mean (range) follow‐up of 3.5 (1.0‐10.0) years were included. The risk of MI was 1.67%/y (95% CI 1.36‐1.98, P het<0.001 for heterogeneity) and decreased over time (P int=0.021); 96% of the heterogeneity between studies was explained by study design, study period, follow‐up duration, mean age, proportion of patients on antithrombotic therapy, and incident versus combined ischemic stroke/transient ischemic attack. The risk of recurrent stroke was 4.26%/y (95% CI 3.43‐5.09, P het<0.001), with no change over time (P int=0.63). The risk of fatal MI was half the risk of recurrent strokes ending in fatality (incidence ratio=0.51, 95% CI 0.14‐0.89, P het=0.58). The risk of nonfatal MI was 75% smaller than the risk of recurrent nonfatal stroke (incidence ratio=0.25, 95%CI 0.02‐0.50, P het=0.68). Male sex, hypertension, coronary and peripheral artery diseases were associated with a doubled risk of MI. After ischemic stroke/transient ischemic attack, the risk of MI is currently <2%/y, and recurrent stroke is a more common cause of death than MI.