Department of Neurosciences, Medical University of South Carolina, Charleston, SC 29425, USA.
Neurology. 2010 Feb 16;74(7):588-93. doi: 10.1212/WNL.0b013e3181cff776.
This study examines the risk of recurrent stroke, myocardial infarction (MI), vascular death, or all-cause death after hospitalized stroke in South Carolina.
Patients with a primary diagnosis of stroke discharged from the year 2002 were identified from the state hospital discharge database. Kaplan-Meier estimates of recurrent stroke, MI, vascular death, all-cause death, and composite events were calculated at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years. Prognostic factors were assessed with multivariate Cox proportional hazard models.
The search strategy identified 10,399 patients in 2002. The Kaplan-Meier estimate of cumulative risk at 1 month, 6 months, 1 year, 2 years, 3 years, and 4 years for recurrent stroke is 1.8%, 5.0%, 8.0%, 12.1%, 15.2%, and 18.1%; MI, 0.3%, 1.0%, 2.1%, 3.7%, 5.0%, and 6.2%; all-cause death, 14.6%, 20.6%, 24.5%, 30.9%, 36.2%, and 41.3%; vascular death, 11.4%, 14.8%, 17.1%, 20.7%, 23.8%, and 26.7%; and composite events of recurrent stroke, MI, or vascular death 13.6%, 19.5%, 24.7%, 31.6%, 36.8%, and 41.3%. The hazard ratio for composite events (recurrent stroke, MI, or death) increases with age (1.38, 1.35-1.41), is 1.12 (1.05-1.19) for African Americans compared to Caucasians, is 1.67 (1.57-1.77) for patients with a higher comorbidity index (> or = 2 vs <2), and is 1.34 (1.28-1.39) for patients with subarachnoid hemorrhage or intracerebral hemorrhage compared with ischemic stroke.
These findings suggest there is room for further improvement in secondary stroke prevention in South Carolina.
本研究旨在调查南卡罗来纳州住院卒中后再次发生卒中、心肌梗死（MI）、血管性死亡或全因死亡的风险。
从州医院出院数据库中确定 2002 年主要诊断为卒中的患者。计算 1 个月、6 个月、1 年、2 年、3 年和 4 年时的再发卒中、MI、血管性死亡、全因死亡和复合事件的 Kaplan-Meier 估计值。采用多变量 Cox 比例风险模型评估预后因素。
搜索策略确定了 2002 年的 10399 名患者。1 个月、6 个月、1 年、2 年、3 年和 4 年时再发卒中的累积风险的 Kaplan-Meier 估计值分别为 1.8%、5.0%、8.0%、12.1%、15.2%和 18.1%；MI 分别为 0.3%、1.0%、2.1%、3.7%、5.0%和 6.2%；全因死亡分别为 14.6%、20.6%、24.5%、30.9%、36.2%和 41.3%；血管性死亡分别为 11.4%、14.8%、17.1%、20.7%、23.8%和 26.7%；再发卒中、MI 或血管性死亡的复合事件分别为 13.6%、19.5%、24.7%、31.6%、36.8%和 41.3%。复合事件（再发卒中、MI 或死亡）的风险比随年龄增加（1.38，1.35-1.41），非裔美国人比白人高 1.12（1.05-1.19），合并症指数（>或=2 与<2）较高的患者为 1.67（1.57-1.77），蛛网膜下腔出血或脑出血患者与缺血性卒中患者相比为 1.34（1.28-1.39）。
这些发现表明，南卡罗来纳州进一步改善二级卒中预防仍有空间。
