Stroke Prevention Research Unit, Nuffield Department of Clinical Neurology, John Radcliffe Hospital, and the University of Oxford, , Oxford, UK.
Heart. 2013 Oct;99(20):1509-14. doi: 10.1136/heartjnl-2013-304207. Epub 2013 Jul 19.
Acute coronary syndrome (ACS) is associated with increased risk of cognitive decline when compared with controls, but case:control studies are subject to selection bias. We therefore compared cognitive outcomes in ACS with transient ischaemic attack (TIA) and minor stroke, diseases with similar risk factor burden generally considered to be at high risk of cognitive decline.
Prospective population based cohort study
Oxford Vascular Study (OXVASC) carried out within a defined population of 91 000 in Oxfordshire, UK.
614 in total: 216 ACS, 182 TIA, 216 minor (non-disabling) stroke.
Mini-Mental-State-Examination (MMSE), Telephone Interview for Cognitive Status-modified (TICSm), and Montreal Cognitive Assessment (MoCA) at 1 and 5 years.
Overall risk factor burden was similar across groups but ACS patients had more smoking (27% vs 14%, p<0.001) and less hypertension (45% vs 53%, p<0.01) and atrial fibrillation (6% vs 14%, p<0.001). Cognitive outcomes were worse at 1 year in ACS versus TIA patients: mean±SD MMSE 26.6±2.7 vs 27.6±2.5, p<0.0001; OR=2.14, 95% CI 1.11 to 4.13 for moderate/severe cognitive impairment (MMSE <24) with a similar trend at 5 years, and ACS outcomes were more similar to minor stroke. Memory and language versus frontal/executive subtests were relatively more impaired in ACS than TIA and minor stroke patients.
Risk of cognitive impairment after ACS is similar to minor stroke and higher than TIA with implications for clinical practice including consent and adherence with medication. Differences in cognitive domain performance suggest a greater role for degenerative brain pathology in ACS which may be linked to vascular risk profile and cardiac factors.
与对照组相比，急性冠状动脉综合征（ACS）与认知能力下降的风险增加相关，但病例对照研究存在选择偏倚。因此，我们比较了 ACS 与短暂性脑缺血发作（TIA）和小卒中的认知结果，这两种疾病具有相似的危险因素负担，通常被认为是认知能力下降的高风险疾病。
前瞻性基于人群的队列研究
英国牛津郡牛津血管研究（OXVASC）在一个明确的 91000 人口中进行。
共 614 例：216 例 ACS，182 例 TIA，216 例小（非致残）卒中。
1 年和 5 年时采用简易精神状态检查（MMSE）、改良电话认知状态检查（TICSm）和蒙特利尔认知评估（MoCA）。
总体风险因素负担在各组之间相似，但 ACS 患者的吸烟率更高（27%比 14%，p<0.001），高血压（45%比 53%，p<0.01）和心房颤动（6%比 14%，p<0.001）的比例更低。ACS 患者的认知结果在 1 年内比 TIA 患者更差：平均±SD MMSE 为 26.6±2.7 比 27.6±2.5，p<0.0001；OR=2.14，95%CI 1.11 至 4.13，用于中度/重度认知障碍（MMSE<24），5 年后有类似趋势，且 ACS 结局与小卒中更相似。ACS 患者的记忆和语言与额叶/执行功能子测验相比，认知障碍相对更严重，TIA 和小卒中患者。
ACS 后认知障碍的风险与小卒中相似，高于 TIA，这对临床实践具有重要意义，包括同意和药物治疗的依从性。认知域表现的差异表明，ACS 中退行性脑病理学的作用更大，这可能与血管风险状况和心脏因素有关。
