Hankey G J, Slattery J M, Warlow C P
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
J Neurol Neurosurg Psychiatry. 1991 Sep;54(9):793-802. doi: 10.1136/jnnp.54.9.793.
A cohort of 469 hospital-referred patients with transient ischaemic attacks (TIA) of the brain (66%) or eye (34%) due to presumed atheromatous thromboembolism, lipohyalinosis or cardiogenic embolism, without prior stroke, was assembled between 1976-86. Follow up was prospective and complete until the patients death or the end of 1986. During a mean period of follow up of 4.1 years there were 82 deaths (58 vascular, 24 non-vascular), 63 first-ever strokes and 58 patients with coronary events. A coronary event accounted for 51% of deaths whilst stroke was the cause in 12%. The average risk of death over the first five years after TIA was 4.5% per year. The risk of stroke was 6.6% in the first year and 3.4% per year on average over the first five years. Stroke occurred in the same vascular territory as the initial TIA in about two-thirds of cases, and was of lacunar type in one fifth of these strokes. The average risk of a coronary event over the first five years after TIA was 3.1% per year, similar to that of stroke. However, the risk of a coronary event, and also death, was fairly constant each year after a TIA, in contrast to the risk of stroke which was highest in the first year. The average risk of stroke, myocardial infarction or vascular death over the first five years after TIA was 6.5% per year and the average risk of stroke, myocardial infarction or death from any cause was 7.5% per year. The prognosis of this cohort of hospital-referred TIA patients was better than that of TIA patients in the same community who presented to the Oxfordshire Community Stroke Project (OCSP), and reflected the impact of referral bias. The hospital-referred patients were younger, assessed at a later date after their last TIA, and comprised a greater proportion of patients who had had a TIA of the eye (amaurosis fugax), which had a better prognosis than TIA of the brain. Knowledge of the prognosis of different populations of TIA patients not only enhances understanding and interpretation of previous studies but is also required for optimal patient management and the planning of treatment trials.
1976年至1986年间，招募了469名因疑似动脉粥样硬化性血栓栓塞、脂肪透明变性或心源性栓塞而出现脑部（66%）或眼部（34%）短暂性脑缺血发作（TIA）的患者，这些患者此前均未发生过中风。随访是前瞻性的且完整，直至患者死亡或1986年底。在平均4.1年的随访期间，有82例死亡（58例血管性死亡、24例非血管性死亡），63例首次中风，58例发生冠状动脉事件。冠状动脉事件导致的死亡占51%，中风导致的死亡占12%。TIA后前五年的平均年死亡风险为4.5%。第一年中风风险为6.6%，前五年平均每年中风风险为3.4%。约三分之二的病例中，中风发生在与初始TIA相同的血管区域，其中五分之一的中风为腔隙性中风。TIA后前五年的平均年冠状动脉事件风险为3.1%，与中风风险相似。然而，与中风风险在第一年最高不同，TIA后每年冠状动脉事件以及死亡的风险相当稳定。TIA后前五年中风、心肌梗死或血管性死亡的平均年风险为6.5%，中风、心肌梗死或任何原因导致的死亡的平均年风险为7.5%。这组转诊至医院的TIA患者的预后优于向牛津郡社区中风项目（OCSP）就诊的同一社区的TIA患者，这反映了转诊偏倚的影响。转诊至医院的患者更年轻，在最后一次TIA后更晚接受评估，且眼部TIA（一过性黑矇）患者占比更大，眼部TIA的预后优于脑部TIA。了解不同人群TIA患者的预后不仅有助于增强对既往研究的理解和解读，也是优化患者管理和规划治疗试验所必需的。
