Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants.
Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants.
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DOI：
10.1136/bmjopen-2015-009535
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发表时间：
2016-01-20
期刊：
影响因子：
2.9
通讯作者：
Sharma P
中科院分区：
文献类型：
--
作者：
Gunnoo T;Hasan N;Khan MS;Slark J;Bentley P;Sharma P
急性中风后，复发的风险很高。然而，中风后死亡的主要原因是冠状动脉疾病 (CAD) 和心肌梗死 (MI)，但这种风险尚未得到可靠量化。我们试图在没有已知心脏病史的情况下可靠地量化急性缺血性卒中（AIS）患者患缺血性心脏病（IHD）的风险。荟萃分析研究。 PubMed、MEDLINE、EMBASE 和 Google Scholar 搜索了截至 2015 年 10 月的潜在研究。纳入的研究报告了一次急性脑缺血事件，并在 1 年内对不知道 IHD 的患者进行了 CAD 或 MI 随访。使用反正弦变换比例进行荟萃分析，并使用通用逆方差随机效应模型将研究组合起来，以计算汇总标准化平均差和 95% CI。这些被解释为 AIS 后 CAD 患病率或 MI 发生率。对 4869 名 AIS 患者进行的 17 项研究表明，无症状 CAD 的平均发病率为 52%。 CAD 检测的解剖方法显示，无症状冠状动脉狭窄≥50% 的患病率为 32%（95% CI 19% 至 47%；p<0.00001）。对 47229 名缺血性中风患者进行的 8 项研究显示，尽管没有任何心脏病史，中风后一年发生 MI 的总体风险为 3%（95% CI 1% 至 5%；p<0.00001）。三分之一没有心脏病史的缺血性中风患者的冠状动脉狭窄超过 50%，3% 的患者有一年内发生心肌梗死的风险。我们的研究结果为无心脏病史的患者 AIS 后发生 IHD 的风险提供了可靠的定量测量。
Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history. A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS. 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥50% coronary stenosis in 32% (95% CI 19% to 47%; p<0.00001). 8 studies with 47229 patients with ischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; p<0.00001) despite the absence of any cardiac history. One-third of patients with ischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history.