颅内和颅外狭窄以及缺血性心脏病并存的缺血性脑卒中患者的长期结局。

Long-term outcomes of ischemic stroke patients with concurrent intracranial and extracranial stenoses and ischemic heart disease.

机构信息

Division of Neurology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China.

出版信息

Cerebrovasc Dis. 2010 Feb;29(3):236-41. doi: 10.1159/000267847.

DOI:10.1159/000267847

PMID:20029196

Abstract

BACKGROUND AND PURPOSE

Coexisting ischemic heart disease (IHD) and concurrent atherosclerosis of intracranial and extracranial vessels is common in Asians. This study aims to investigate the long-term outcomes of ischemic stroke patients with concurrent stenoses and IHD.

METHODS

This was a prospective cohort study in Hong Kong. Consecutive Chinese patients with acute ischemic stroke underwent MRI, magnetic resonance angiography and carotid duplex sonography.

RESULTS

A total of 428 patients were included. The mean follow-up period was 65 months (up to 87 months). Ninety-three patients (22%) died of any cause and 104 patients (22%) suffered from nonfatal vascular events. Fifty-four patients (13%) had IHD. Among them, 27 patients (50%) had concurrent stenoses. In patients with concurrent stenoses and IHD, only 3 (11%) were free of death and recurrent vascular events. Eight (30%) had recurrent nonfatal stroke, 7 (26%) had nonfatal myocardial infarct (MI) and 11 (41%) died, 6 (22%) of them due to fatal MI. The overall 5-year cumulative rates of mortality, recurrent vascular events and combined poor outcomes were 21, 23 and 43%, respectively. In patients with concurrent stenoses and IHD, these rates were 40, 50 and 83%, respectively. More deaths (log rank: 6.56; p = 0.01), recurrent vascular events (log rank: 25.24; p < 0.001) and poor outcomes (log rank: 27.50; p < 0.001) were found among patients with concurrent stenoses and IHD.

CONCLUSIONS

Ischemic stroke patients with concurrent stenoses and IHD had high risks of death and recurrent vascular events. Future studies on aggressive medical therapy and early cardiac interventions in this high-risk group of stroke patients are warranted.

摘要

背景与目的

在亚洲人群中，同时患有缺血性心脏病（IHD）和颅内及颅外血管粥样硬化是很常见的。本研究旨在探讨同时患有狭窄和 IHD 的缺血性脑卒中患者的长期预后。

方法

这是一项在香港进行的前瞻性队列研究。连续入组的急性缺血性脑卒中中国患者接受 MRI、磁共振血管造影和颈动脉双功能超声检查。

结果

共纳入 428 例患者。平均随访时间为 65 个月（最长 87 个月）。93 例（22%）患者死于任何原因，104 例（22%）患者发生非致死性血管事件。54 例（13%）患者患有 IHD。其中，27 例（50%）患者同时存在狭窄。在同时患有狭窄和 IHD 的患者中，仅有 3 例（11%）无死亡和复发性血管事件。8 例（30%）患者复发非致死性脑卒中，7 例（26%）患者发生非致死性心肌梗死（MI），11 例（41%）患者死亡，其中 6 例（22%）死于致命性 MI。总的 5 年累积死亡率、复发性血管事件和联合不良结局发生率分别为 21%、23%和 43%。在同时患有狭窄和 IHD 的患者中，这些发生率分别为 40%、50%和 83%。同时患有狭窄和 IHD 的患者死亡（对数秩检验：6.56；p = 0.01）、复发性血管事件（对数秩检验：25.24；p < 0.001）和不良结局（对数秩检验：27.50；p < 0.001）的风险更高。