Dutta Dipankar, Bowen Emily, Foy Chris
From the Stroke Service (D.D., E.B.) and Research Design Service (C.F.), Gloucestershire Royal Hospital, Gloucester, UK.
Stroke. 2015 May;46(5):1227-32. doi: 10.1161/STROKEAHA.114.008632. Epub 2015 Mar 26.
There is limited information on outcomes from rapid access transient ischemic attack (TIA) clinics. We present 4-year outcomes of TIAs, strokes, and mimics from a UK TIA clinic database.
All patients referred between April 2010 and May 2012 were retrospectively identified and outcomes determined. End points were stroke, myocardial infarction, any vascular event (TIA, stroke, or myocardial infarction), and all-cause death. Data were analyzed by survival analysis.
Of 1067 patients, 31.6% were TIAs, 18% strokes, and 50.4% mimics. Median assessment time was 4.5 days from onset and follow-up was for 34.9 months. Subsequent strokes occurred in 7.1% of patients with TIA, 10.9% of patients with stroke, and 2.0% of mimics at the end of follow-up. Stroke risk at 90 days was 1.3% for patients diagnosed as TIA or stroke. Compared with mimics, hazard ratios for subsequent stroke were 3.88 (1.90-7.91) for TIA and 5.84 (2.81-12.11) for stroke. Hazard ratio for any subsequent vascular event was 2.91 (1.97-4.30) for TIA and 2.83 (1.81-4.41) for stroke. Hazard ratio for death was 1.68 (1.10-2.56) for TIA and 2.19 (1.38-3.46) for stroke.
Our results show a lower 90-day stroke incidence after TIA or minor stroke than in earlier studies, suggesting that rapid access daily TIA clinics may be having a significant effect on reducing strokes.
关于快速就诊短暂性脑缺血发作（TIA）门诊的预后信息有限。我们展示了来自英国一个TIA门诊数据库的TIA、卒中及疑似病例的4年预后情况。
对2010年4月至2012年5月间转诊的所有患者进行回顾性识别并确定预后。终点指标为卒中、心肌梗死、任何血管事件（TIA、卒中或心肌梗死）及全因死亡。采用生存分析对数据进行分析。
1067例患者中，31.6%为TIA，18%为卒中，50.4%为疑似病例。从发病到中位评估时间为4.5天，随访时间为34.9个月。随访结束时，TIA患者中有7.1%发生后续卒中，卒中患者中有10.9%发生后续卒中，疑似病例中有2.0%发生后续卒中。诊断为TIA或卒中的患者90天时的卒中风险为1.3%。与疑似病例相比，TIA后续卒中的风险比为3.88（1.90 - 7.91），卒中后续卒中的风险比为5.84（2.81 - 12.11）。TIA任何后续血管事件的风险比为2.91（1.97 - 4.30），卒中为2.83（1.81 - 4.41）。TIA死亡的风险比为1.68（1.10 - 2.56），卒中为2.19（1.38 - 3.46）。
我们的结果显示，TIA或轻度卒中后90天的卒中发生率低于早期研究，这表明快速就诊的每日TIA门诊可能对减少卒中具有显著作用。
