Division of Cardiovascular and Medical Sciences, Gardiner Institute, Faculty of Medicine, University of Glasgow, Glasgow, UK.
Int J Stroke. 2011 Aug;6(4):306-11. doi: 10.1111/j.1747-4949.2011.00591.x. Epub 2011 Mar 16.
Many patients who attend transient ischemic attack clinics have a noncerebrovascular diagnosis. The long-term outcomes in this group are not well described. We evaluated these in a cohort referred to a transient ischemic attack clinic with a suspected transient ischemic attack.
Patients were clinically classified as having stroke or a transient ischemic attack or a noncerebrovascular diagnosis (nontransient ischemic attack). Follow-up was via electronic record linkage. The primary endpoint was cardiovascular death or a major cardiovascular event. Secondary outcomes included incident neurological disease (excluding stroke or transient ischemic attack) and the need for permanent pacemaker insertion. Outcomes in the transient ischemic attack and nontransient ischemic attack cohorts were compared using Cox's proportional hazards models. Mortality outcomes were further compared with those in a contemporary control group of individuals with hypertension.
Of the 3533 patients who attended the transient ischemic attack clinic, 53.5% had a transient ischemic attack. Of these, 769 (40.7%) suffered a cardiovascular endpoint, compared with 458 (27.9%) with a nontransient ischemic attack (hazard ratio 1.53, 95% confidence interval 1.36-1.72). The risk remained higher but was attenuated following adjustment (hazard ratio 1.21, 95% confidence interval 1.05-1.41). Cardiovascular mortality in both groups was higher than that in hypertensive controls. The risk of a subsequent nonstroke neurological event was higher in those without a transient ischemic attack.
Patients without a transient ischemic attack referred to a transient ischemic attack clinic have a high risk of future vascular events that exceeds risk in a cohort with hypertension. All patients attending transient ischemic attack clinics should undergo assessment of their cardiovascular risk and the use of methods to reduce this risk should be explored.
许多到短暂性脑缺血发作（TIA）门诊就诊的患者存在非脑血管疾病诊断。目前尚不清楚该人群的长期预后。我们评估了一个因疑似 TIA 而转诊至 TIA 门诊的队列中的这些患者。
根据临床诊断，患者被分为发生了脑卒中或 TIA 或非脑血管疾病（非 TIA）。通过电子病历进行随访。主要终点是心血管死亡或重大心血管事件。次要结局包括新发神经系统疾病（不包括脑卒中或 TIA）和永久性起搏器植入的需求。使用 Cox 比例风险模型比较 TIA 和非 TIA 队列的结局。进一步将死亡率与同时期高血压患者的对照组进行比较。
在 3533 例就诊于 TIA 门诊的患者中，53.5%为 TIA。其中，769 例（40.7%）发生了心血管终点事件，而非 TIA 患者中 458 例（27.9%）发生（风险比 1.53，95%置信区间 1.36-1.72）。调整后风险仍然较高，但有所减弱（风险比 1.21，95%置信区间 1.05-1.41）。两组的心血管死亡率均高于高血压对照组。无 TIA 的患者发生非脑卒中神经系统事件的风险更高。
转诊至 TIA 门诊的无 TIA 患者未来发生血管事件的风险较高，超过了高血压患者的风险。所有到 TIA 门诊就诊的患者均应进行心血管风险评估，并探索降低风险的方法。
