Side of brain infarction and long-term risk of sudden death in patients with symptomatic carotid disease
Side of brain infarction and long-term risk of sudden death in patients with symptomatic carotid disease
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DOI：
10.1161/01.str.0000099964.34430.2d
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发表时间：
2003-12-01
期刊：
影响因子：
8.3
通讯作者：
Barnett, HJM
中科院分区：
文献类型：
--
作者：
Algra, A;Gates, PC;Barnett, HJM
背景和目的-目前的出版物表明，急性右岛叶病变的实验动物和近期右侧脑梗死的患者猝死的风险增加，特别是如果涉及脑梗死。我们长期以来一直-在2885例有症状的颈动脉疾病患者中，基线脑扫描和利手的存在和脑梗死侧的猝死风险。在1295例无脑梗死患者中，5年猝死风险为5.3%（24小时定义）;左侧梗死患者（n = 471）为8.8%;右侧梗死患者（n = 477）为6.0%;双侧梗死患者（n = 535）为9.7%。在考虑其他风险因素的差异后在考克斯回归分析中，与无心肌梗死相比的校正风险比（HR）如下：左侧HR，1.45（95%置信区间[ CI]，1.00 - 2.10）;右侧HR，0.96（95% CI，0.62 - 1.47）;双侧HR，1.40（95% CI，0.98 - 2.00）。41例发生岛状梗死，无猝死。左撇子或左右手患者（n = 183）的猝死风险低于右撇子;左撇子或左右手患者的校正HR为0.24（95%CI，0.07至0.70）。这些结果对于10分钟和60分钟的猝死定义基本上是相同的。结论-在长期，左侧，而不是右侧，脑梗死与猝死的风险增加。左撇子或左右手患者猝死的风险比右撇子患者低，这表明大脑的作用。
Background and Purpose - Current publications suggest increased risk of sudden death in experimental animals with acute right insular lesions and in patients with recent right- sided brain infarction, particularly if the insula is involved.Methods - Using 3 different time definitions, we related long- term risk of sudden death to presence and side of brain infarction on the baseline brain scan and handedness in 2885 patients with symptomatic carotid disease.Results - In 1295 patients without brain infarction, 5- year risk of sudden death was 5.3% ( 24- hour definition); in those with left- sided infarction ( n = 471), 8.8%; in those with right- sided infarction ( n = 477), 6.0%; and in those with bilateral infarction ( n = 535), 9.7%. After accounting for differences of other risk factors ( eg, previous myocardial infarction) in Cox regression, adjusted hazard ratios ( HRs) compared with no infarction were as follows: left- sided HR, 1.45 ( 95% confidence interval [ CI], 1.00 to 2.10); right- sided HR, 0.96 ( 95% CI, 0.62 to 1.47); and bilateral HR, 1.40 ( 95% CI, 0.98 to 2.00). Insular infarction occurred in 41 patients; none died suddenly. Left- handed or ambidextrous patients ( n = 183) had a lower risk of sudden death than right- handers; the adjusted HR for left- handed or ambidextrous patients was 0.24 ( 95% Cl, 0.07 to 0.70). These results were essentially the same for the 10- and 60- minute definitions of sudden death.Conclusions - In the long- term, left- sided, not right- sided, brain infarction is associated with increased risk of sudden death. Left- handed or ambidextrous patients have a lower risk of sudden death than right- handed patients, suggesting a role for the brain.