Howard G, Evans G W, Thomas J L, Ryu J E, Kahl F R, Crouse J R
Department of Public Health Sciences, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC 27103.
Stroke. 1991 May;22(5):582-5. doi: 10.1161/01.str.22.5.582.
The prevailing belief that transient ischemic attack is a risk factor for cardiovascular morbidity and mortality is based primarily on comparisons of survival of patients after transient ischemic attacks to that of an age-, race-, and sex-adjusted general population. Concomitant conditions that carry a high risk of premature mortality or morbidity, such as ischemic heart disease, hypertension, and diabetes, are very prevalent among patients with transient ischemic attacks. Hence, the poor prognosis of such patients may be attributable to these factors rather than their transient ischemic attack per se, which may only serve to bring patients into the medical system. We compared the survival of 336 patients after transient ischemic attack to that of a control group with a similar risk factor profile consisting of 6,710 patients evaluated for cardiac catheterization. Survival estimates, both unadjusted and adjusted for risk factors, did not differ between the two groups. Three-year survival estimates, after adjustment to the mean value of covariates, were 94% for the patients with transient ischemic attacks and 91% for the controls. These results suggest that the transient ischemic attack may not be an independent risk factor for mortality, although it may identify patients already at increased risk from coexisting conditions.
普遍认为短暂性脑缺血发作是心血管疾病发病和死亡的危险因素，这一观点主要基于对短暂性脑缺血发作患者与按年龄、种族和性别调整的普通人群的生存率比较。伴有过早死亡或发病高风险的合并症，如缺血性心脏病、高血压和糖尿病，在短暂性脑缺血发作患者中非常普遍。因此，这类患者预后不良可能归因于这些因素，而非短暂性脑缺血发作本身，短暂性脑缺血发作可能只是促使患者进入医疗系统。我们将336例短暂性脑缺血发作患者的生存率与一个由6710例接受心脏导管检查评估、具有相似危险因素特征的对照组进行了比较。两组之间未调整和调整危险因素后的生存估计值并无差异。在将协变量调整至均值后，短暂性脑缺血发作患者的三年生存估计值为94%，对照组为91%。这些结果表明，短暂性脑缺血发作可能不是死亡的独立危险因素，尽管它可能识别出因并存疾病而已经处于风险增加状态的患者。
