Types of Stroke Recurrence in Patients with Ischemic Stroke: A Substudy from the PRoFESS Trial
Types of Stroke Recurrence in Patients with Ischemic Stroke: A Substudy from the PRoFESS Trial
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DOI：
10.1111/ijs.12150
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发表时间：
2014-10
影响因子：
6.7
通讯作者：
D. Toni;E. Di Angelantonio;M. D. Di Mascio;R. Vinisko;P. Bath
中科院分区：
文献类型：
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作者：
D. Toni;E. Di Angelantonio;M. D. Di Mascio;R. Vinisko;P. Bath
背景中风复发的风险特征不明确。目的：我们确定指数缺血性卒中亚型之间卒中复发风险和类型的变化，以及指数卒中亚型和传统卒中风险因素是否是卒中复发的预测因子。方法本研究纳入了有效避免二次卒中预防方案试验的患者。结果1794例患者中，复发性卒中亚型与指标卒中相同的有：大动脉粥样硬化性卒中占48.3%，心源性卒中占50%，小动脉闭塞性卒中占48.7%，其他病因卒中占8.1%，病因不明卒中占45.3%。心源性卒中患者不愿或不能口服抗凝剂，卒中复发的风险最大。多变量分析中卒中复发的预测因素为：大动脉粥样硬化血栓性卒中中的高龄和既往卒中;小动脉闭塞性卒中中的高龄、男性、既往卒中、既往短暂性脑缺血发作、高血压、糖尿病和吸烟;心源性卒中中的高龄;其他病因卒中中的房颤和抗糖尿病药物;病因不明的卒中中，年龄较大、既往卒中史和房颤。脑出血作为复发性卒中的预测因子是指数小动脉闭塞性卒中、年龄较大、既往卒中史和阿司匹林联合缓释双嘧达莫抗血小板治疗。结论卒中复发和脑出血的风险预测因子因缺血性卒中亚型指数而异，这些信息在启动二级预防治疗时是重要的。
Background Risk profiles for stroke recurrence are poorly characterized. Aims We determined the variation in the risk and type of recurrent stroke among index ischemic stroke subtypes, and whether index stroke subtype and conventional stroke risk factors were predictors of stroke recurrence. Methods Patients enrolled in the Prevention Regimen for Effectively Avoiding Second Strokes trial were included in this study. Results In 1794 patients' recurrent stroke subtypes were the same as the index stroke in: 48·3% of patients with large artery atherothrombosis stroke; 50% of patients with cardioembolic stroke; 48·7% of patients with small artery occlusion stroke; 8·1% of patients with stroke of other etiology, and 45·3% of patients with undetermined etiology stroke. Patients with cardioembolic stroke, who were unwilling or unable to take oral anticoagulants, had the greatest risk of stroke recurrence. Predictors of stroke recurrence in multivariable analysis were: older age and previous stroke among large artery atherothrombosis strokes; older age, male sex, previous stroke, previous transient ischemic attack, hypertension, diabetes, and tobacco use among small artery occlusion strokes; older age among cardioembolic strokes; atrial fibrillation and anti-diabetic medications among other etiology strokes; older age, previous stroke and atrial fibrillation among undetermined etiology strokes. Predictors of brain hemorrhage as recurrent stroke were index small artery occlusion stroke, older age, previous stroke, and antiplatelet treatment with aspirin plus extended-release dipyridamole. Conclusions Risk predictors for stroke recurrence and for brain hemorrhage differ by index ischemic stroke subtype, information that is important when initiating secondary prevention therapy.