Department of Neurology, Donders Institute for Brain, Cognition, and Behavior, Radboud University Nijmegen Medical Center, Nijmegen.
Ann Neurol. 2013 Oct;74(4):592-601. doi: 10.1002/ana.23953. Epub 2013 Jul 3.
Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke.
We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA), ischemic stroke, or intracerebral hemorrhage (ICH), aged 18 to 50 years, admitted to our hospital between January 1, 1980 and November 1, 2010. Outcomes were (1) stroke; (2) myocardial infarction or cardiac or peripheral arterial revascularization procedures; or (3) composite event of these, whichever occurred first.
After a mean follow-up of 9.1 years (standard deviation = 8.2, range = 0-31.0), 142 patients (19.6%) had at least 1 recurrent vascular event. Cumulative 20-year risk of stroke was 17.3% (95% confidence interval [CI] = 9.5-25.1) after TIA, 19.4% (95% [CI] = 14.6-24.3) after ischemic stroke, and 9.8% (95% CI = 1.0-18.7) after ICH. Cumulative 20-year risk of any vascular event was 27.7% (95% CI = 18.5-37.0) after TIA and 32.8% (95% CI = 26.7-38.9) after ischemic stroke. Age and male sex were associated with other arterial events, but not with stroke. Among TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes, adjusted for age, sex, and decennium of inclusion, atherothrombotic stroke, cardioembolic stroke, and lacunar stroke were associated with recurrent stroke (hazard ratio [HR] = 2.72, 95% CI = 1.34-5.52; HR = 2.49, 95% CI = 1.23-5.07; and HR = 2.92, 95% CI = 1.45-5.88, respectively).
Patients with young stroke remain at substantial risk of recurrent vascular events for decades, suggesting that the underlying disease that caused stroke at a young age continues to put these patients at a high risk for vascular disease throughout their lives.
关于青年卒中后复发性血管事件的长期数据有限。我们的目的是研究青年卒中后复发性血管事件的长期风险。
我们前瞻性纳入了 1980 年 1 月 1 日至 2010 年 11 月 1 日期间因首次短暂性脑缺血发作（TIA）、缺血性卒中和颅内出血（ICH）住院的 724 例连续患者，年龄 18-50 岁。结局为（1）卒中；（2）心肌梗死或心脏或外周动脉血运重建手术；或（3）这些疾病中的任意一种首发的复合事件。
在平均 9.1 年（标准差=8.2，范围=0-31.0）的随访后，142 例患者（19.6%）至少发生了 1 次复发性血管事件。TIA 后 20 年卒中累积风险为 17.3%（95%置信区间[CI]：9.5-25.1），缺血性卒中和 ICH 后分别为 19.4%（95%CI：14.6-24.3）和 9.8%（95%CI：1.0-18.7）。TIA 后 20 年任何血管事件的累积风险为 27.7%（95%CI：18.5-37.0），缺血性卒中后为 32.8%（95%CI：26.7-38.9）。年龄和男性与其他动脉事件相关，但与卒中无关。在 TOAST（急性卒中治疗Org 10172 试验）亚型中，按年龄、性别和纳入的十年进行调整后，动脉粥样硬化血栓形成性卒中和心源性栓塞性卒中和腔隙性卒中与复发性卒中相关（风险比[HR]：2.72，95%CI：1.34-5.52；HR：2.49，95%CI：1.23-5.07；和 HR：2.92，95%CI：1.45-5.88）。
青年卒中患者在数十年内仍然存在复发性血管事件的高风险，这表明导致年轻时卒中的潜在疾病使这些患者终生面临高血管疾病风险。
