Dennis M, Bamford J, Sandercock P, Warlow C
University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, England.
Stroke. 1990 Jun;21(6):848-53. doi: 10.1161/01.str.21.6.848.
In a community-based study of approximately 105,000 people, 184 presented with a transient ischemic attack during the 5 years between 1981 and 1986; we believe these persons represent almost all new cases of transient ischemic attack going to a doctor during that period. During a mean follow-up of 3.7 years 49 patients died, 45 had a first-ever stroke, and 17 had a myocardial infarction. Cardiac disease accounted for 17 (35%) deaths, while stroke was the cause of death in 15 patients (31%). The average actuarial risk of death was approximately 6.3%/yr, slightly greater than that expected for similar people without transient ischemic attacks (risk ratio [observed divided by expected] = 1.4). The actuarial risk of stroke was 11.6% during the first year after a transient ischemic attack and approximately 5.9%/yr over the first 5 years. Patients who suffered a transient ischemic attack had a 13-fold excess risk of stroke during the first year and a sevenfold excess risk over the first 7 years compared with people without transient ischemic attacks. The actuarial risk of death, stroke, or myocardial infarction over the first 5 years after a transient ischemic attack was approximately 8.4%/yr. The prognosis in this community-based cohort was better than that in previous reports. The high early risk of stroke means that investigation and treatment of new cases should commence as soon as possible.
在一项针对约105,000人的社区研究中，1981年至1986年的5年间有184人出现短暂性脑缺血发作；我们认为这些人几乎代表了该时期所有因短暂性脑缺血发作而去看医生的新病例。在平均3.7年的随访期内，49例患者死亡，45例首次发生中风，17例发生心肌梗死。心脏病导致17例（35%）死亡，而中风是15例患者（31%）的死因。平均精算死亡风险约为每年6.3%，略高于无短暂性脑缺血发作的相似人群预期的风险（风险比[观察值除以预期值]=1.4）。短暂性脑缺血发作后第一年中风的精算风险为11.6%，头5年约为每年5.9%。与无短暂性脑缺血发作的人相比，发生短暂性脑缺血发作的患者在第一年中风风险高出13倍，头7年高出7倍。短暂性脑缺血发作后头5年死亡、中风或心肌梗死的精算风险约为每年8.4%。该社区队列的预后比以往报告中的要好。中风早期风险高意味着新病例的调查和治疗应尽快开始。
