One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke
One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke
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DOI：
10.1056/nejmoa1412981
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发表时间：
2016-04-21
影响因子：
158.5
通讯作者：
Wong, Lawrence K. S.
中科院分区：
文献类型：
--
作者：
Amarenco, Pierre;Lavallee, Philippa C.;Wong, Lawrence K. S.
背景先前在 1997 年至 2003 年间进行的研究估计，在短暂性脑缺血发作 (TIA) 或轻微中风后的前 3 个月内，中风或急性冠状动脉综合征的风险为 12% 至 20%。 TIAregistry.org 项目旨在描述在卫生系统中接受护理的 TIA 或轻微缺血性中风患者的当代概况、病因因素和结果，这些患者现在由中风专家提供紧急评估。方法我们招募了在过去 7 天内患有 TIA 或轻微中风的患者。如果站点拥有专门用于紧急评估 TIA 患者的系统，则将选择这些站点。我们估计了中风的 1 年风险以及中风、急性冠状动脉综合征或心血管原因死亡的复合结局。我们还检查了 ABCD(2) 评分与中风风险（范围，0 [最低风险]至 7 [最高风险]）、脑成像结果以及 TIA 或轻微中风原因与 1 年内复发中风风险之间的关系。 结果 从 2009 年到 2011 年，我们在 21 个国家的 61 个地点招募了 4789 名患者。总共 78.4% 的患者在症状出现后 24 小时内接受了卒中专家的评估。共有33.4%的患者患有急性脑梗塞，23.2%的患者患有至少一项颅外或颅内狭窄50%以上，10.4%的患者患有房颤。 Kaplan-Meier 估计的复合心血管结局的 1 年事件率为 6.2%（95% 置信区间，5.5 至 7.0）。 Kaplan-Meier 估计第 2、7、30、90 和 365 天的中风发生率分别为 1.5%、2.1%、2.8%、3.7% 和 5.1%。在多变量分析中，脑影像学上的多发性梗死、大动脉粥样硬化以及 ABCD(2) 评分为 6 或 7 均与中风风险增加一倍以上相关。结论我们观察到 TIA 后心血管事件的风险比之前报道的要低。 ABCD(2) 评分、脑成像结果以及大动脉粥样硬化状态有助于对 TIA 或轻微中风后 1 年内复发中风的风险进行分层。
BACKGROUNDPrevious studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists.METHODSWe recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD(2) score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year.RESULTSFrom 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan-Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan-Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD(2) score of 6 or 7 were each associated with more than a doubling of the risk of stroke.CONCLUSIONSWe observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD(2) score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke.