In-hospital prognosis of first-ever noncardiogenic ischemic stroke in patients with and without indication for prestroke antiplatelet therapy: Chinese Stroke Center Alliance.
In-hospital prognosis of first-ever noncardiogenic ischemic stroke in patients with and without indication for prestroke antiplatelet therapy: Chinese Stroke Center Alliance.
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有或没有卒中前抗血小板治疗指征的首次非心源性缺血性卒中患者的院内预后：中国卒中中心联盟
DOI：
10.21037/atm-20-7902
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发表时间：
2021-04
影响因子：
--
通讯作者：
Wang YJ
中科院分区：
文献类型：
--
作者：
Xu YY;Gu HQ;Li ZX;Xiong YY;Zhou Q;Liu LP;Zhao XQ;Wang YL;Meng X;Wang YJ
背景目前尚不清楚卒中前抗血小板治疗对有或无该指征患者早期预后的影响。我们的目的是评估首次非心源性缺血性脑卒中患者的住院预后，有无抗血小板用于一级预防的指征。方法：基于前瞻性医院登记（中国卒中中心联盟）的回顾性观察性研究。利用2015年8月1日至2019年7月31日中国1453家医院记录的436660例首次非心源性急性缺血性卒中的数据，我们研究了卒中前抗血小板使用适应症与院内临床结局之间的关系。结果在436660例首次非心源性缺血性脑卒中患者中，42409例（9.7%）患者既往有血管指征，394251例（90.3%）患者无血管指征。与没有该适应症的患者相比，有该适应症的患者住院发病率增加，包括卒中严重程度（OR 2.71; 95% CI: 2.62-2.81； P<0.0001）、住院时间（OR 1.16; 95% CI: 1.13-1.19； P<0.0001）、死亡率（OR 2.20; 95% CI: 1.96-2.46， P<0.0001）、缺血性卒中和短暂性脑缺血发作（TIA）的复发（OR 1.5; 95% CI: 1.43-1.59， P<0.0001）。在无指征的患者中，卒中前抗血小板使用与较低的死亡率相关（OR 0.73, 95% CI: 0.56-0.96； P=0.0221）；而在有适应证的患者中，接受卒中前抗血小板治疗的患者卒中严重程度（P<0.0001）和残疾（P=0.0003）的优势比低于未接受治疗的患者。结论卒中前有抗血小板适应症的患者比无适应症的患者更容易出现不良结局。在某些人群中，中风前抗血小板可能与较低的死亡率、较低的致残率和较低的中风严重程度有关。未来的研究需要完善风险预测规则，以指导有效的缺血性脑卒中一级预防。
Background It is unknown about the influence of prestroke antiplatelet use on early outcomes in patients with and without the indication. We aimed to evaluate the in-hospital prognosis of first-ever noncardiogenic ischemic stroke patients with and without indications of antiplatelet use for primary prevention. Methods This was a retrospective, observational study based on a prospective hospital-based registry (Chinese Stroke Center Alliance). Using the data with 436,660 first-ever noncardiogenic acute ischemic strokes recorded from Aug 1, 2015, to July 31, 2019, from 1,453 hospitals in China, we examined the associations between the indication for prestroke antiplatelet use and in-hospital clinical outcomes. Results Among 436,660 first-ever noncardiogenic ischemic stroke patients, 42,409 patients (9.7%) had a documented previous vascular indication and 394,251 (90.3%) did not. Compared to those without, patients with the indication were associated with increased prevalence of in-hospital morbid conditions, including stroke severity (OR 2.71; 95% CI: 2.62–2.81; P<0.0001), length of stay >14 days (OR 1.16; 95% CI: 1.13–1.19; P<0.0001), mortality (OR 2.20; 95% CI: 1.96–2.46, P<0.0001), and recurrence of ischemic stroke and transient ischemic attack (TIA) (OR 1.5; 95% CI: 1.43–1.59, P<0.0001). Among patients without indication, prestroke antiplatelet use was associated with lower mortality (OR 0.73, 95% CI: 0.56–0.96; P=0.0221); while among patients with indication, those receiving prestroke antiplatelet had lower odds ratios in stroke severity (P<0.0001) and disability (P=0.0003) than those who not. Conclusions Patients with indications of prestroke antiplatelet use were more likely to have unfavorable outcomes than those without. Prestroke antiplatelet might be associated with lower mortality, less disability, and less stroke severity in certain population groups. Future studies to improve risk prediction rules are needed to guide effective primary prevention for ischemic stroke.
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影响因子：
8.3
作者：
Meschia JF;Bushnell C;Boden-Albala B;Braun LT;Bravata DM;Chaturvedi S;Creager MA;Eckel RH;Elkind MS;Fornage M;Goldstein LB;Greenberg SM;Horvath SE;Iadecola C;Jauch EC;Moore WS;Wilson JA;American Heart Association Stroke Council;Council on Cardiovascular and Stroke Nursing;Council on Clinical Cardiology;Council on Functional Genomics and Translational Biology;Council on Hypertension
通讯作者：
Council on Hypertension
影响因子：
37.8
作者：
Cooney, Marie Therese;Dudina, Alexandra;Graham, Ian M.
通讯作者：
Graham, Ian M.
影响因子：
3.3
作者：
Aboyans, Victor;Ricco, Jean-Baptiste;Desormais, Ileana
通讯作者：
Desormais, Ileana
影响因子：
2.8
作者：
Barlas, Raphae S.;Loke, Yoon K.;Myint, Phyo K.
通讯作者：
Myint, Phyo K.
影响因子：
5.1
作者：
Bejot, Y.;Aboa-Eboule, C.;Giroud, M.
通讯作者：
Giroud, M.