Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Ann Neurol. 2010 Nov;68(5):661-71. doi: 10.1002/ana.22091.
Data on recurrence of vascular events and their prognostic factors in young (<50 years of age) stroke patients are not well defined.
We assessed the occurrence of arterial thrombotic events in consecutive first-ever ischemic stroke patients aged 15 to 49 years entered into the Helsinki Young Stroke Registry (January 1994-October 2004) within 5-year follow-up. Follow-up was conducted with a structured telephone interview or letter, and review of all patient records; mortality data came from Statistics Finland. Primary outcomes were (1) nonfatal or fatal recurrent ischemic stroke; (2) nonfatal or fatal myocardial infarct, other arterial thrombotic event, or revascularization procedure; and (3) any combination of these, whichever occurred first (composite endpoint). We used Kaplan-Meier analysis to estimate cumulative risks and Cox proportional hazard model-adjusted for age, gender, relevant risk factors, and stroke subtype-for identifying predictors of recurrence.
In the 807 patients followed (mean age, 41.5 ± 7.4 years; 62.9% male), cumulative 5-year recurrence rate was 9.4% (95% confidence interval [CI], 7.3-11.5%) for nonfatal or fatal ischemic stroke, 2.4% (95% CI, 1.3-3.5%) for nonfatal or fatal myocardial infarct or other arterial endpoint, and 11.5% (95% CI, 9.2-13.7%) for the composite endpoint. Independent predictors of the composite endpoint were type 1 diabetes mellitus (hazard ratio [HR], 4.39; 95% CI, 2.28-8.45), large-artery atherosclerosis underlying the index stroke (HR, 2.82; 95% CI, 1.36-5.83), heart failure (HR, 2.96; 95% CI, 1.17-7.50), previous transient ischemic attack (HR, 2.33; 95% CI, 1.40-3.88), and increasing age (HR, 1.05; 95% CI, 1.01-1.10).
Despite their young age, these individuals were at marked risk of recurrent arterial events, predicted by mostly modifiable baseline factors.
年轻（<50 岁）卒中患者的血管事件复发及其预后因素的数据尚不明确。
我们评估了连续入组的年龄在 15 至 49 岁的首次缺血性卒中患者（1994 年 1 月至 2004 年 10 月）在 5 年随访期间的动脉血栓栓塞事件的发生情况。通过结构化电话访谈或信件以及对所有患者记录的回顾进行随访；死亡率数据来自芬兰统计数据。主要结局为（1）非致死性或致死性复发性缺血性卒中；（2）非致死性或致死性心肌梗死、其他动脉血栓栓塞事件或血运重建术；以及（3）这些事件的任意组合（复合终点）。我们使用 Kaplan-Meier 分析来估计累积风险，并使用 Cox 比例风险模型进行调整，以评估年龄、性别、相关危险因素和卒中亚型对复发的预测作用。
在 807 例随访患者（平均年龄 41.5±7.4 岁，62.9%为男性）中，5 年的累积复发率为非致死性或致死性缺血性卒中 9.4%（95%置信区间，7.3-11.5%），非致死性或致死性心肌梗死或其他动脉终点为 2.4%（95%置信区间，1.3-3.5%），复合终点为 11.5%（95%置信区间，9.2-13.7%）。复合终点的独立预测因素包括 1 型糖尿病（风险比 [HR]，4.39；95%置信区间，2.28-8.45）、索引性卒中的大动脉粥样硬化（HR，2.82；95%置信区间，1.36-5.83）、心力衰竭（HR，2.96；95%置信区间，1.17-7.50）、既往短暂性脑缺血发作（HR，2.33；95%置信区间，1.40-3.88）和年龄增加（HR，1.05；95%置信区间，1.01-1.10）。
尽管这些患者年龄较轻，但由于存在多种可改变的基线因素，他们发生复发性动脉事件的风险显著增加。
