Ois Angel, Cuadrado-Godia Elisa, Jiménez-Conde Jordi, Gomis Meritxell, Rodríguez-Campello Ana, Martínez-Rodríguez Jose E, Munteis Elvira, Roquer Jaume
Unitat d'Ictus, Servei de Neurologia, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, IMIM-Hospital del Mar, Barcelona, Barcelona, Spain.
Stroke. 2007 Jul;38(7):2085-9. doi: 10.1161/STROKEAHA.107.482950. Epub 2007 May 24.
The purpose of this study was to evaluate the value of the initial arterial study as a predictor of 90-day mortality in patients with acute ischemic stroke.
A total of 1220 unselected patients assessed during the first 24 hours after stroke onset were prospectively studied. Initial stroke severity was evaluated by the National Institutes of Health Stroke Scale and dichotomized in mild (National Institutes of Health Stroke Scale < or =7) and severe (National Institutes of Health Stroke Scale >7). Severe arterial stenosis (> or =70%) or arterial occlusion in the symptomatic territory was determined by a Doppler study and also by additional explorations (carotid duplex, MR or CT angiography) in the first 24 hours after admission. The following variables were also analyzed: age, gender, previous functional status, smoking, hypertension, hyperlipidemia, diabetes mellitus, peripheral arterial disease, ischemic heart disease, heart failure, atrial fibrillation, previous stroke, and prior use of antithrombotic or statins. Ninety-day mortality was the end point of the study.
Ninety-day mortality was 15.7%. A total of 25.5% of all deaths were in patients with mild stroke. In addition to well-known factors related to mortality (age, stroke severity, ischemic heart disease, heart failure, and previous disability), severe arterial stenosis/occlusion was the factor with the highest relationship with 90-day mortality (adjusted OR: stenosis 2.13, occlusion 4.42, both 3.36). Arterial stenosis/occlusion was a higher predictor of 90-day mortality in patients with mild (adjusted OR: 5.38) than severe stroke (adjusted OR: 3.05).
Severe arterial stenosis/occlusion in the early arterial study was highly related with 90-day mortality in an unselected series of patients with stroke. These data achieve special relevance in patients with initial mild stroke.
本研究旨在评估初始动脉检查对急性缺血性卒中患者90天死亡率的预测价值。
前瞻性研究了1220例在卒中发作后24小时内接受评估的未经过筛选的患者。初始卒中严重程度采用美国国立卫生研究院卒中量表（NIHSS）进行评估，并分为轻度（NIHSS≤7）和重度（NIHSS＞7）。在入院后24小时内，通过多普勒检查以及其他检查（颈动脉双功超声、磁共振血管造影或CT血管造影）确定症状性区域的严重动脉狭窄（≥70%）或动脉闭塞情况。还分析了以下变量：年龄、性别、既往功能状态、吸烟、高血压、高脂血症、糖尿病、外周动脉疾病、缺血性心脏病、心力衰竭、心房颤动、既往卒中以及既往使用抗血栓药物或他汀类药物的情况。90天死亡率为研究的终点。
90天死亡率为15.7%。所有死亡患者中，25.5%为轻度卒中患者。除了与死亡率相关的已知因素（年龄、卒中严重程度、缺血性心脏病、心力衰竭和既往残疾）外，严重动脉狭窄/闭塞是与90天死亡率关系最为密切的因素（校正比值比：狭窄为2.13，闭塞为4.42，两者均为3.36）。动脉狭窄/闭塞对轻度卒中患者90天死亡率的预测价值高于重度卒中患者（校正比值比：轻度卒中为5.38，重度卒中为3.05）。
在未经筛选的卒中患者系列中，早期动脉检查发现的严重动脉狭窄/闭塞与90天死亡率高度相关。这些数据在初始为轻度卒中的患者中具有特殊意义。
