INSERM U-698 and Paris-Diderot University, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.
Stroke. 2010 Feb;41(2):261-6. doi: 10.1161/STROKEAHA.109.566380. Epub 2009 Dec 31.
The purpose of this study was to assess the prevalence of embolic signals (ES) in acute coronary syndromes (ACS) and their association with stroke.
From December 2004 to October 2006, 209 consecutive patients with ACS (without prosthetic heart valves or previous stroke) were studied within 72 hours of symptom onset. Patients underwent ES monitoring in both middle cerebral arteries by transcranial Doppler for 30 minutes. Median follow-up was 14 months after discharge.
Patients were treated according to current European Society Cardiology guidelines. Specifically, 92% of patients received heparin(s), 100% aspirin, 92% clopidogrel, 67% intravenous glycoprotein IIb/IIIa inhibitors, 9% fibrinolysis, and 67% underwent angioplasty. ES were detected in 7 patients (prevalence 3.4%; 95% CI, 1.4 to 6.8). Except for a higher prevalence of ES in patients with unstable angina versus other ACS categories (8.5% versus 1.9%, P=0.047), none of the factors among baseline characteristics, clinical features, ACS treatment, and cardiac findings were associated with the presence of ES. During hospitalization, 3 patients without ES had cerebrovascular events (one stroke and 2 transient ischemic attacks), whereas no cerebrovascular events occurred in patients with ES.
The prevalence of ES among hospitalized patients with ACS is currently low, possibly because of improvement in ACS treatment. In this ACS sample, ES did not appear associated with short-term risk of cerebrovascular events.
本研究旨在评估急性冠脉综合征（ACS）中栓子信号（ES）的发生率及其与卒中的关系。
2004 年 12 月至 2006 年 10 月，在症状发作后 72 小时内，对 209 例连续患有 ACS（无人工心脏瓣膜或既往卒中）的患者进行研究。患者接受经颅多普勒检查双侧大脑中动脉 ES 监测 30 分钟。中位随访时间为出院后 14 个月。
根据欧洲心脏病学会指南对患者进行治疗。具体而言，92%的患者接受肝素，100%的患者接受阿司匹林，92%的患者接受氯吡格雷，67%的患者接受静脉注射糖蛋白 IIb/IIIa 抑制剂，9%的患者接受纤溶治疗，67%的患者接受经皮冠状动脉介入治疗。7 例患者（发生率 3.4%；95%CI，1.4%至 6.8%）检测到 ES。除不稳定型心绞痛患者 ES 的发生率高于其他 ACS 类别（8.5%与 1.9%，P=0.047）外，基线特征、临床特征、ACS 治疗和心脏检查中无任何因素与 ES 的存在相关。在住院期间，3 例无 ES 的患者发生脑血管事件（1 例卒中和 2 例短暂性脑缺血发作），而 ES 患者均未发生脑血管事件。
目前 ACS 住院患者 ES 的发生率较低，可能是由于 ACS 治疗的改善。在本 ACS 样本中，ES 似乎与短期脑血管事件风险无关。
