van Wijk I, Kappelle L J, van Gijn J, Koudstaal P J, Franke C L, Vermeulen M, Gorter J W, Algra A
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, Netherlands.
Lancet. 2005;365(9477):2098-104. doi: 10.1016/S0140-6736(05)66734-7.
Determinants of survival and of risk of vascular events after transient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke (Rankin grade< or =3), after 10 years or more.
We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis.
Follow-up was complete in 2447 (99%) patients. After a mean follow-up of 10.1 years, 1489 (60%) patients had died and 1336 (54%) had had at least one vascular event. 10-year risk of death was 42.7% (95% CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33 (2.97-3.73) for age over 65 years, 2.10 (1.79-2.48) for diabetes, 1.77 (1.45-2.15) for claudication, 1.94 (1.42-2.65) for previous peripheral vascular surgery, and 1.50 (1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1% (42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death.
Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.
短暂性脑缺血发作（TIA）或轻度缺血性卒中后长期生存及血管事件风险的决定因素尚不明确。我们旨在对TIA或轻度缺血性卒中（Rankin分级≤3级）患者的前瞻性队列进行10年或更长时间的再次研究，以评估这些风险。
我们评估了荷兰TIA试验中2473名参与者（1986 - 1989年招募；脑缺血的动脉病因）的生存状况和血管事件的发生情况。我们纳入了荷兰的24家医院，每家医院至少招募了50名患者。主要结局为全因死亡率以及所有血管病因导致的死亡、非致死性卒中、非致死性心肌梗死的复合事件。我们通过Kaplan - Meier分析评估累积风险，并通过Cox单因素和多因素分析评估预后因素。
2447名（99%）患者完成了随访。平均随访10.1年后，1489名（60%）患者死亡，1336名（54%）患者至少发生了一次血管事件。10年死亡风险为%（95%CI 40.8 - 44.7）。年龄和性别调整后的风险比，65岁以上为3.33（2.97 - 3.73），糖尿病为2.10（1.79 - 2.48），间歇性跛行为1.77（1.45 - 2.15），既往外周血管手术为1.94（1.42 - 2.65），基线心电图出现病理性Q波为1.50（1.31 - 1.71）。10年血管事件风险为44.1%（42.0 - 46.1）。在最初3年下降后，血管事件的年风险随时间增加。血管事件风险的预测因素与死亡风险的预测因素相似。
脑缺血患者的长期二级预防仍有进一步改善的空间。
