Clark T G, Murphy M F G, Rothwell P M
Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
J Neurol Neurosurg Psychiatry. 2003 May;74(5):577-80. doi: 10.1136/jnnp.74.5.577.
Previous studies of prognosis after a transient ischaemic attack (TIA) have recruited patients soon after the event, when the risk of stroke is very high. However, the majority of patients survive for many years after a TIA, and the need for continued preventive treatment to lower vascular risk will need to be reassessed at a later date.
To determine the long term risks of stroke and other vascular events in patients with TIA who survive the initial high risk period.
290 patients were studied who had initially been followed up after a TIA in the Oxford community stroke project and in a contemporaneous hospital based cohort study, and who were alive and stroke-free at the end of planned follow up in 1988. All patients were followed for a further 10 years, and the risks of major vascular events (stroke, myocardial infarction, vascular death) were determined. Standardised mortality ratios (SMR) were calculated from the observed numbers of fatal events and the number expected on the basis of age and sex in the general population.
Median time since last TIA was 3.8 years (interquartile range, 2.2 to 5.8 years). The risk of major vascular events was constant through time. The 10 year risk of first stroke was 18.8% (95% confidence interval (CI), 13.6 to 23.7; 45 events). The 10 year risk of myocardial infarction or death from coronary heart disease was 27.8% (95% CI, 21.8 to 33.3; 67 events) and there was a significant excess of fatal coronary events compared with that expected in the general population (SMR = 1.47; 95% CI, 1.10 to 1.93; p = 0.009). A total of 114 patients had at least one major vascular event, with a 10 year risk of any first stroke, myocardial infarction, or vascular death of 42.8% (95% CI, 36.4 to 48.5).
The overall risk of major vascular events remains high for 10 to 15 years after a TIA. It is important therefore that preventive treatments are continued in the long term, even in apparently "low risk" patients who have already survived free of stroke for several years.
既往短暂性脑缺血发作（TIA）后的预后研究在事件发生后不久就招募了患者，此时卒中风险非常高。然而，大多数TIA患者在发作后存活多年，后期需要重新评估继续进行预防性治疗以降低血管风险的必要性。
确定度过初始高风险期存活的TIA患者发生卒中和其他血管事件的长期风险。
对290例患者进行研究，这些患者最初在牛津社区卒中项目及同期一项基于医院的队列研究中因TIA接受随访，且在1988年计划随访结束时仍存活且未发生卒中。所有患者进一步随访10年，确定主要血管事件（卒中、心肌梗死、血管性死亡）的风险。根据观察到的致命事件数量及基于一般人群年龄和性别的预期数量计算标准化死亡比（SMR）。
自上次TIA以来的中位时间为3.8年（四分位间距，2.2至5.8年）。主要血管事件的风险随时间保持恒定。首次卒中的10年风险为18.8%（95%置信区间（CI），13.6至23.7；45例事件）。心肌梗死或冠心病死亡的10年风险为27.8%（95%CI，21.8至33.3；67例事件），与一般人群相比，致命性冠状动脉事件显著过多（SMR = 1.47；95%CI，1.10至1.93；p = 0.009）。共有114例患者发生至少一次主要血管事件，首次发生卒中、心肌梗死或血管性死亡的10年风险为42.8%（95%CI，36.4至48.5）。
TIA后10至15年主要血管事件的总体风险仍然很高。因此，长期持续进行预防性治疗很重要，即使是那些已经多年未发生卒中的明显“低风险”患者。
