An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke
An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke
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DOI：
10.1212/wnl.0b013e3182a08d59
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发表时间：
2013-08-13
期刊：
影响因子：
9.9
通讯作者：
Thaler, David E.
中科院分区：
文献类型：
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作者：
Kent, David M.;Ruthazer, Robin;Thaler, David E.
目的：我们的目的是建立一个指数来分层隐源性中风（CS）患者与卵圆孔未闭（PFO）的可能性，中风是相关的PFO.Methods：使用数据从12个组成部分的研究，我们使用广义线性混合模型来预测存在的PFO与CS患者之间，并得出一个简单的指数来分层CS患者。我们估计了特定的层PFO可归因的分数和特定的层中风/TIA复发率。结果：CS患者与PFO相关的变量包括年龄较小，神经影像学上存在皮质中风，以及这些因素的情况下：糖尿病，高血压，吸烟，和以前的中风或TIA。根据这些变量计算10分的副动脉栓塞风险评分，以便最年轻的浅表卒中患者和无血管风险因素的患者具有最高评分。PFO患病率从0 - 3分的23%（95%置信区间[CI]：19%-26%）增加到9或10分的73%（95% CI：66%-79%），对应于约0%-90%的可归因分数估计值。Kaplan-Meier估计的卒中/TIA 2年复发率从20%降低至（95% CI：12%-28%），最低副动脉栓塞风险评分分层为2%（95%CI：0%-4%）最高。临床特征确定CS患者在PFO患病率方面差异显著，反映了发现的PFO可能是卒中相关与偶然的概率的临床重要变化。更有可能发生卒中相关PFO的患者复发风险较低。
Objective: We aimed to create an index to stratify cryptogenic stroke (CS) patients with patent foramen ovale (PFO) by their likelihood that the stroke was related to their PFO.Methods: Using data from 12 component studies, we used generalized linear mixed models to predict the presence of PFO among patients with CS, and derive a simple index to stratify patients with CS. We estimated the stratum-specific PFO-attributable fraction and stratum-specific stroke/TIA recurrence rates.Results: Variables associated with a PFO in CS patients included younger age, the presence of a cortical stroke on neuroimaging, and the absence of these factors: diabetes, hypertension, smoking, and prior stroke or TIA. The 10-point Risk of Paradoxical Embolism score is calculated from these variables so that the youngest patients with superficial strokes and without vascular risk factors have the highest score. PFO prevalence increased from 23% (95% confidence interval [CI]: 19%-26%) in those with 0 to 3 points to 73% (95% CI: 66%-79%) in those with 9 or 10 points, corresponding to attributable fraction estimates of approximately 0% to 90%. Kaplan-Meier estimated stroke/TIA 2-year recurrence rates decreased from 20% (95% CI: 12%-28%) in the lowest Risk of Paradoxical Embolism score stratum to 2% (95% CI: 0%-4%) in the highest.Conclusion: Clinical characteristics identify CS patients who vary markedly in PFO prevalence, reflecting clinically important variation in the probability that a discovered PFO is likely to be stroke-related vs incidental. Patients in strata more likely to have stroke-related PFOs have lower recurrence risk.