Deitelzweig Steven B, Ogbonnaya Augustina, Berenson Karina, Lamerato Lois E, Costas Julian P, Makenbaeva Dinara, Corbelli John
Department of Hospital Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
Hosp Pract (1995). 2010 Nov;38(4):7-17. doi: 10.3810/hp.2010.11.335.
Atherothrombosis is a systemic disease that may manifest as acute ischemic events in multiple vascular beds. Patients who have experienced an atherothrombosis-related ischemic event in 1 vascular bed are at risk for developing ischemic events in other vascular beds. Antiplatelet therapy demands an understanding of the balance between arterial thrombosis benefit and adverse event risk. Clinical trials indicate that dual antiplatelet therapy with aspirin and the newer thienopyridines increases the risk of bleeding in patients with acute coronary syndromes (ACS) with prior cerebrovascular events. Informed clinical decision making requires a better understanding of the real-world prevalence of cerebrovascular events.
To estimate the prevalence of stroke and/or transient ischemic attack (TIA) among patients with ACS within US health plan populations.
A retrospective, observational cohort study was conducted of patients with ACS in 5 health care claims databases. The index event was defined as the first documented inpatient health care claim for myocardial infarction or unstable angina. Patients with ≥12 months of pre-index medical care encounter information were included. Stroke/TIA was identified by the first health care claim for these conditions any time prior to or within 90 days following the index ACS event.
Across all databases, between 3.8% and 15.7% of patients with ACS had prior stroke/TIA and between 3.4% and 11.7% of patients with ACS with no history of cerebrovascular events had documented stroke/TIA following the index ACS hospitalization.
Despite important differences between the various database populations, there is a high prevalence of documented stroke/TIA in patients with ACS both prior to and following the ACS event. These real-world findings, set within the context of the increased bleeding risk observed with the newer thienopyridines, are important considerations when selecting antiplatelet therapy for patients with ACS.
动脉粥样硬化血栓形成是一种全身性疾病，可在多个血管床表现为急性缺血事件。在一个血管床发生过动脉粥样硬化血栓形成相关缺血事件的患者，有在其他血管床发生缺血事件的风险。抗血小板治疗需要了解动脉血栓形成获益与不良事件风险之间的平衡。临床试验表明，对于既往有脑血管事件的急性冠状动脉综合征（ACS）患者，阿司匹林与新型噻吩并吡啶类药物联合抗血小板治疗会增加出血风险。明智的临床决策需要更好地了解脑血管事件在现实世界中的患病率。
评估美国医疗保健计划人群中ACS患者发生卒中及/或短暂性脑缺血发作（TIA）的患病率。
对5个医疗保健理赔数据库中的ACS患者进行了一项回顾性观察队列研究。索引事件定义为首次记录的心肌梗死或不稳定型心绞痛住院医疗理赔。纳入索引事件前有≥12个月医疗护理接触信息的患者。在索引ACS事件之前或之后90天内，通过首次针对这些疾病的医疗保健理赔来确定卒中/TIA。
在所有数据库中，3.8%至15.7%的ACS患者既往有卒中/TIA，3.4%至11.7%无脑血管事件史的ACS患者在索引ACS住院后记录有卒中/TIA。
尽管不同数据库人群之间存在重要差异，但ACS患者在ACS事件之前和之后，记录的卒中/TIA患病率都很高。在新型噻吩并吡啶类药物出血风险增加的背景下，这些现实世界的研究结果是为ACS患者选择抗血小板治疗时的重要考虑因素。
