Azarpazhooh Mahmoud Reza, Nicol Marcus B, Donnan Geoffrey A, Dewey Helen M, Sturm Jonathan W, Macdonell Richard A L, Pearce Dora C, Thrift Amanda G
National Stroke Research Institute, Austin Health, Heidelberg, Victoria, Australia.
Int J Stroke. 2008 Aug;3(3):158-64. doi: 10.1111/j.1747-4949.2008.00204.x.
Specific information about the nature of recurrent events that occur after each subtype of index stroke may be useful for refining preventive therapies. We aimed to determine whether stroke recurrence rates, the pattern of subtype recurrence, and prescription of secondary prevention agents differed according to initial stroke subtype.
Multiple overlapping sources were used to recruit all first-ever stroke patients from a geographically defined region of Melbourne, Australia over a 3-year period from 1996 to 1999. Potential stroke recurrences (fatal and nonfatal) occurring within 2 years of the initial event were identified following patient interview and follow up of death records. Subjects were classified into the different Oxfordshire groups and the type of first-ever stroke was compared with recurrent stroke events.
One thousand, three hundred and sixteen first-ever strokes were registered during the 3-year period (mean age 74.4 years). A total of 103 first recurrent stroke events (fatal and nonfatal) occurred among those with a first-ever ischemic stroke or intracerebral hemorrhage (ICH) during the 2-year follow-up period. The recurrent stroke subtype was different to the index stroke subtype in most (78%) patients. People with partial anterior circulation infarct had the greatest proportion of recurrences (13%), with a third of these being the more severe total anterior circulation infarct subgroup. The relative risk of ICH after an index lacunar infarct (LACI) compared with an index non-LACI was 4.06 (95% CI 1.10-14.97, P=0.038). Prescription of secondary prevention agents was greater at 2 years after stroke than at hospital discharge, and was similar between ischemic stroke subtypes.
Approximately 9% of people with first-ever stroke suffered a recurrent event, despite many being prescribed secondary prevention agents. This has implications for the uptake of current preventive strategies and the development of new strategies. The possibility that ICH is greater among index LACI cases needs to be confirmed.
有关首次中风各亚型后复发性事件性质的具体信息，可能有助于优化预防性治疗。我们旨在确定中风复发率、亚型复发模式以及二级预防药物的处方是否因首次中风亚型而异。
在1996年至1999年的3年期间，使用多个重叠来源从澳大利亚墨尔本一个地理区域招募所有首次中风患者。在患者访谈和死亡记录随访后，确定首次事件后2年内发生的潜在中风复发（致命和非致命）情况。将受试者分为不同的牛津郡组，并比较首次中风类型与复发性中风事件。
在3年期间共登记了1316例首次中风（平均年龄74.4岁）。在2年随访期内，首次缺血性中风或脑出血（ICH）患者中共有103例首次复发性中风事件（致命和非致命）。在大多数（78%）患者中，复发性中风亚型与首次中风亚型不同。部分前循环梗死患者的复发比例最高（13%），其中三分之一是更严重的全前循环梗死亚组。与非腔隙性梗死（LACI）相比，腔隙性梗死（LACI）后发生ICH的相对风险为4.06（95%CI 1.10 - 14.97，P = 0.038）。中风后2年二级预防药物的处方比出院时更多，且缺血性中风亚型之间相似。
尽管许多首次中风患者被开具了二级预防药物，但仍有大约9%的患者发生了复发性事件。这对当前预防策略的采用和新策略的开发具有启示意义。需要确认在首次LACI病例中ICH发生率更高的可能性。
