Chiu Lai Hong Simon, Yau Wah Hon, Leung Ling Pong, Pang Peter, Tsui Chee Tat, Wan Kuang An, Au Thomas Tak-Shun, Fong Wing Chi, Chung Shun Hang Joseph
Accident and Emergency Department at Princess Margret Hospital, Hong Kong, SAR, PR China.
Accident and Emergency Department at Queen Elizabeth Hospital, Hong Kong, SAR, PR China.
Cerebrovasc Dis Extra. 2014 Mar 5;4(1):40-51. doi: 10.1159/000360074. eCollection 2014 Jan.
Literature on prognosis of transient ischemic attack (TIA) in Chinese is scarce. The short-term prognosis of TIA and the predictive value of the ABCD(2) score in Hong Kong Chinese patients attending the emergency department (ED) were studied to provide reference for TIA patient management in our ED.
A cohort of TIA patients admitted through the ED to 13 acute public hospitals in 2006 was recruited through the centralized electronic database by the Hong Kong Hospital Authority (HA). All inpatients were e-coded by the HA according to the International Classification of Diseases, Ninth Revision (ICD9). Electronic records and hard copies were studied up to 90 days after a TIA. The stroke risk of a separate TIA cohort diagnosed by the ED was compared.
In the 1,000 recruited patients, the stroke risk after a TIA at days 2, 7, 30, and 90 was 0.2, 1.4, 2.9, and 4.4%, respectively. Antiplatelet agents were prescribed in 89%, warfarin in 6.9%, statin in 28.6%, antihypertensives in 39.3%, and antidiabetics in 11.9% of patients after hospitalization. Before the index TIA, the prescribed medications were 27.6, 3.7, 11.3, 27.1, and 9.7%, respectively. The accuracy of the ABCD(2) score in predicting stroke risk was 0.607 at 7 days, 0.607 at 30 days, and 0.574 at 90 days. At 30 days, the p for trend across ABCD(2) score levels was 0.038 (OR for every score point = 1.36, p = 0.040). Diabetes mellitus, previous stroke and carotid bruit were associated with stroke within 90 days (p = 0.038, 0.045, 0.030, respectively). A total of 45.4% of CTs of the brain showed lacunar infarcts or small vessel disease. There was an increased stroke risk at 90 days in patients with old or new infarcts on CT or MRI. Patients with carotid stenosis ≥70% had an increased stroke risk within 30 (OR = 6.335, p = 0.013) and 90 days (OR = 3.623, p = 0.050). Stroke risks at days 2, 7, 30, and 90 in the 289 TIA patients diagnosed by the ED were 0.35, 2.4, 5.2, and 6.2%, respectively.
The short-term stroke risk in Hong Kong Chinese TIA patients is low. The administered nonurgent treatment cannot solely explain the favorable outcome, the lower risk can be due to the different pathophysiological mechanisms of stroke between Caucasians and Chinese. The predictive value of the ABCD(2) score is low in our population.
关于短暂性脑缺血发作（TIA）预后的中文文献较少。本研究旨在探讨香港华人急诊科（ED）就诊的TIA患者的短期预后及ABCD(2)评分的预测价值，为我院急诊科TIA患者的管理提供参考。
通过香港医院管理局（HA）的集中电子数据库，招募2006年通过急诊科收治入13家急性公立医院的TIA患者队列。所有住院患者均由HA根据国际疾病分类第九版（ICD9）进行电子编码。对TIA后90天内的电子记录和纸质记录进行研究。比较急诊科诊断的另一TIA队列的卒中风险。
在招募的1000例患者中，TIA后第2天、第7天、第30天和第90天的卒中风险分别为0.2%、1.4%、2.9%和4.4%。住院后，89%的患者使用了抗血小板药物，6.9%使用了华法林，28.6%使用了他汀类药物，39.3%使用了抗高血压药物，11.9%使用了抗糖尿病药物。在首次TIA之前，相应药物的使用比例分别为27.6%、3.7%、11.3%、27.1%和9.7%。ABCD(2)评分预测卒中风险的准确性在第7天为0.607，第30天为0.607，第90天为0.574。在第30天，ABCD(2)评分水平的趋势p值为0.038（每增加一个评分点的OR = 1.36，p = 0.040）。糖尿病、既往卒中史和颈动脉杂音与90天内卒中相关（p分别为0.038、0.045、0.030）。45.4%的脑部CT显示腔隙性梗死或小血管疾病。CT或MRI显示有陈旧性或新发梗死的患者在90天时卒中风险增加。颈动脉狭窄≥70%的患者在30天内（OR = 6.335，p = 0.013）和90天内（OR = 3.623，p = 0.050）卒中风险增加。急诊科诊断的289例TIA患者在第2天、第7天、第30天和第90天的卒中风险分别为0.35%、2.4%、5.2%和6.2%。
香港华人TIA患者的短期卒中风险较低。所给予的非紧急治疗不能完全解释良好的预后，较低的风险可能是由于白种人和华人之间卒中的病理生理机制不同。在我们的人群中，ABCD(2)评分的预测价值较低。
