Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic-Mestizo Population in Iquique, Chile (PISCIS project):: a community-based incidence study
Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic-Mestizo Population in Iquique, Chile (PISCIS project):: a community-based incidence study
复制标题
DOI：
10.1016/s1474-4422(06)70684-6
复制
发表时间：
2007-02-01
期刊：
影响因子：
48
通讯作者：
Alvarez, Gonzalo
中科院分区：
文献类型：
--
作者：
Lavados, Pablo M.;Sacks, Claudio;Alvarez, Gonzalo
缺血性卒中亚型的发病率，按病因分类，似乎在不同社区之间存在差异。我们的目的是前瞻性地确定首次缺血性中风的发病率在北方沙漠地区的智利.Methods在2000年7月和2002年6月之间，所有可能的中风或短暂性脑缺血发作的患者从多个重叠的来源，并迅速评估了两个领域的神经学家。所有确定的患者均由至少两名卒中神经科医生根据急性卒中治疗试验10172（吐司）的定义进行诊断，并在6个月时进行随访。每年的发病率调整到WHO，欧洲和美国人口的直接方法，以允许comparations.Findings-共确定了239缺血性中风，其中185（77%）是首次病例。151例（82%）患者住院，其中仅70例（38%）在症状发作后6小时内接受评估。患者的平均年龄为66.4岁（SD 14.9），56%为男性。根据卒中亚型的粗年发病率（每10万人）为：心源性栓塞，9.3;大动脉疾病，2.0;小血管疾病，15.8;其他确定的原因，0.2;和未确定的原因，17.4。高血压是所有亚型中最常见的心血管危险因素，房颤是心源性栓塞性卒中的最常见原因。30天病死率在心源性卒中中最高（28%），在小血管疾病中最低（0%）。6个月时的依赖性或死亡在心源性卒中中也最高（62%），在小血管疾病中最低（21%）。小血管和心源性栓塞性梗死的发病率和预后与其他人群相似，大动脉粥样硬化血栓性梗死的发病率低于大多数以前的报道。高血压和房颤分别是该人群中缺血性卒中最常见的危险因素和原因。这些发现应该有助于国家中风计划预防心源性中风，增加获得专家和急性脑成像和血管研究，并改善中风护理。
Background Incidence of ischaemic stroke subtypes, classified by cause, seems to vary between communities. We aimed to prospectively ascertain the incidence of first-ever ischaemic stroke in a predominantly Hispanic-Mestizo population in the northern desertic region of Chile.Methods Between July, 2000, and June, 2002, all patients with possible stroke or transient ischaemic attacks were identified from multiple overlapping sources and were rapidly assessed by two field neurologists. All identified patients were diagnosed by at least two stroke neurologists according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) definitions and were followed up at 6 months. Annual incidence rates were age adjusted to WHO, European, and US populations by the direct method to allow comparisons.Findings A total of 239 ischaemic strokes were identified, of which 185 (77%) were first-ever cases. 151 (82%) patients were hospitalised, of whom only 70 (38%) were assessed within 6 h of symptom onset. The mean age of patients was 66.4 years (SD 14.9) and 56% were men. The crude annual incidence rates (per 100 000) according to stroke subtype were: cardioembolic, 9.3; large-artery disease, 2.0; small-vessel disease, 15.8; other determined cause, 0.2; and undetermined cause, 17.4. Hypertension was the most common cardiovascular risk factor in all subtypes and atrial fibrillation was the most common cause of cardioembolic stroke. Case fatality at 30 days was highest in cardioembolic strokes (28%) and lowest in small-vessel disease (0%). Dependency or death at 6 months was also highest in cardioembolic strokes (62%) and lowest in small-vessel disease (21%).Interpretation Incidence and prognosis of small vessel and cardioembolic infarction was similar to that in other populations and incidence of large-artery atherothrombotic infarction was lower than in most previous reports. Hypertension and atrial fibrillation were the most common risk factor and cause, respectively, of ischemic stroke in this population. These findings should help the national stroke programme in the prevention of cardioembolic stroke, increase access to specialists and acute brain imaging and vascular studies, and improve stroke care.