Cosker K, Samson S, Fagot-Campagna A, Woimant F, Tuppin P
CNAMTS, direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France.
Département de neurologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
Rev Neurol (Paris). 2016 Feb;172(2):152-9. doi: 10.1016/j.neurol.2015.06.008. Epub 2015 Aug 28.
Characteristics of patients hospitalized for transient ischemic attack (TIA) management before and during this hospitalization and follow-up are not well documented on very large populations.
Among the 51 million beneficiaries of the French national health insurance general scheme (77% of French population), those subjects hospitalized for a first TIA in 2010 were included using the national health insurance information system (SNIIRAM). The frequencies of comorbidities during the previous five years and drug treatments received during the previous year and the first month after discharge were estimated from the SNIIRAM and then compared to data derived from the permanent randomized sample of all health insurance beneficiaries based on standardized morbidity ratios (SMR). The three-year outcome and factors associated with at least one readmission for TIA or ischemic stroke during the three months following the first hospitalization were investigated.
A total of 18,181 patients were included (mean age: 69 years, 55% of women). The crude incidence of hospitalized TIA was 0.36 per 1000. Before hospitalization, patients presented a significantly higher rate of carotid and cerebral atherosclerosis (2.4% SMR=1.4), atrial fibrillation (9.1%, SMR=1.3), ischemic heart disease (13.7%, SMR=1.3), valvular heart disease (9.7%, SMR=1.5), and treatment with platelet aggregation inhibitors (29%, SMR=1.4), antihypertensives (60%, SMR=1.2) and antidiabetics (16%, SMR=1.5). These SMR decreased with age. One month after discharge from hospital, 82% of patients still alive filled at least one prescription for antithrombotic therapy (platelet aggregation inhibitor: 74%, vitamin K antagonist: 12%), one class of antihypertensive in 57% of patients, an antiarrhythmic in 9% of patients, an antidiabetic treatment in 14% of patients and a lipid-lowering agent in 53%. During the month following discharge from hospital, 3.2% of patients were readmitted at least once for TIA, 1.9% were readmitted for ischemic stroke and 1.5% of patients died. These figures were 3.9%, 2.4% and 2.9% at three months, and 7.2%, 5% and 16.3% at three years, respectively. On multivariate analysis, factors associated with readmission for TIA or ischemic stroke were age ≥ 65 years and antidiabetic treatment before hospitalization. In contrast, male gender, admission to a stroke unit and length of stay were associated with a lower readmission rate.
These results illustrate the value of administrative databases to study TIA. Hospitalizations for TIA were relatively frequent and the recurrence rate was similar to that reported in similar recent studies. Level of primary and secondary prevention must be improved.
关于短暂性脑缺血发作（TIA）患者在本次住院治疗前、住院期间及随访阶段的特征，目前尚无针对大规模人群的详尽记录。
在法国国家健康保险总计划的5100万受益者（占法国人口的77%）中，利用国家健康保险信息系统（SNIIRAM）纳入了2010年因首次TIA住院的患者。通过SNIIRAM估算过去五年的合并症发生频率以及出院前一年和出院后第一个月接受的药物治疗情况，然后基于标准化发病比（SMR）与所有健康保险受益者的永久随机样本得出的数据进行比较。对首次住院后三个月内至少因TIA或缺血性卒中再次入院的三年结局及相关因素进行了调查。
共纳入18181例患者（平均年龄：69岁，女性占55%）。住院TIA的粗发病率为每1000人中有0.36例。住院前，患者颈动脉和脑动脉粥样硬化发生率显著更高（2.4%，SMR = 1.4）、房颤（9.1%，SMR = 1.3）、缺血性心脏病（13.7%，SMR = 1.3）、心脏瓣膜病（9.7%，SMR = 1.5），且接受血小板聚集抑制剂治疗（29%，SMR = 1.4）、抗高血压药治疗（60%，SMR = 1.2）和抗糖尿病药治疗（16%，SMR = 1.5）。这些SMR随年龄增长而降低。出院后一个月，82%仍存活的患者至少开具了一种抗血栓治疗药物处方（血小板聚集抑制剂：74%，维生素K拮抗剂：12%），57%的患者开具了一类抗高血压药，9%的患者开具了抗心律失常药，1
