Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea.
Eur Heart J. 2013 Sep;34(35):2760-7. doi: 10.1093/eurheartj/eht185. Epub 2013 May 31.
Although use of antithrombotic agents is recommended after ischaemic stroke or transient ischaemic attack (TIA), long-term outcome of secondary prevention between stroke subtypes has not yet been explored.
We used data from the Korean Stroke Registry (KSR), a nationwide, multicentre, prospective registry for acute stroke patients. Patients with acute ischaemic stroke or TIA within 7 days of onset were consecutively enrolled between January 2002 and September 2010. A total of 46 108 patients with ischaemic stroke and TIA were included in this study. Among the major stroke subtypes, stroke due to small vessel occlusion (SVO) showed the lowest mortality, whereas cardioembolic stroke (CE) was associated with the fatal prognosis during the follow-up [for SVO: hazard ratio (HR) 0.66, 95% CI 0.62-0.71; for CE: HR 1.41, 95% CI 1.30-1.53; large artery atherosclerosis (LAA) group as a reference]. Regarding secondary prevention, antiplatelet polytherapy was better than monotherapy in the patients with LAA-related stroke in prognosis [HR 0.89, 95% CI 0.80-0.98]. Anticoagulant therapy was associated with better outcome than antiplatelet monotherapy in CE-related stroke [HR 0.66, 95% CI 0.59-0.74]. In SVO-related stroke group, antiplatelet polytherapy failed to show benefits over monotherapy. Additionally, the risk of death was higher with anticoagulant therapy in the patients with SVO-related stroke [HR 1.44, CI 95% 1.06-1.97].
Our study demonstrated that stroke subtype affects prognosis and also determines the effectiveness of secondary prevention.
尽管建议缺血性卒中和短暂性脑缺血发作（TIA）后使用抗血栓药物，但卒中亚型的二级预防的长期结果尚未得到探索。
我们使用了韩国卒中登记（KSR）的数据，该登记是一个全国性的、多中心的急性卒中患者前瞻性登记。在 2002 年 1 月至 2010 年 9 月期间，发病后 7 天内连续招募了急性缺血性卒中和 TIA 患者。共有 46108 例缺血性卒中和 TIA 患者纳入本研究。在主要卒中亚型中，小血管闭塞（SVO）引起的卒中死亡率最低，而心源性栓塞（CE）与随访期间的致命预后相关[对于 SVO：风险比（HR）0.66，95%CI 0.62-0.71；对于 CE：HR 1.41，95%CI 1.30-1.53；大动脉粥样硬化（LAA）组作为参考]。关于二级预防，在与 LAA 相关的卒中患者中，抗血小板三联疗法比单药治疗的预后更好[HR 0.89，95%CI 0.80-0.98]。与抗血小板单药治疗相比，抗凝治疗与 CE 相关卒中的更好结局相关[HR 0.66，95%CI 0.59-0.74]。在 SVO 相关卒中组中，抗血小板三联疗法未能显示优于单药治疗的益处。此外，在 SVO 相关卒中患者中，抗凝治疗的死亡风险更高[HR 1.44，95%CI 1.06-1.97]。
本研究表明，卒中亚型会影响预后，也决定了二级预防的有效性。
