心肌梗死幸存者中风的长期风险：基于人群的30年队列研究。
Long-Term Risk of Stroke in Myocardial Infarction Survivors: Thirty-Year Population-Based Cohort Study.
作者信息
Sundbøll Jens, Horváth-Puhó Erzsébet, Schmidt Morten, Pedersen Lars, Henderson Victor W, Bøtker Hans Erik, Sørensen Henrik Toft
机构信息
From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (J.S., E.H.P., M.S., L.P., V.W.H.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark (J.S., M.S., H.E.B.); and Departments of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Neurology and Neurological Sciences (V.W.H.), Stanford University, Stanford, CA.
出版信息
Stroke. 2016 Jul;47(7):1727-33. doi: 10.1161/STROKEAHA.116.013321. Epub 2016 Jun 14.
BACKGROUND AND PURPOSE
Improved survival after myocardial infarction (MI) has increased the number of patients at risk of post-MI stroke. We examined risks of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in patients with MI compared with the general population.
METHODS
We conducted a nationwide population-based cohort study using Danish medical registries. During 1980 to 2009, we identified all patients with a first-time inpatient diagnosis of MI and formed a sex- and age-matched comparison cohort. We computed cumulative stroke risks and adjusted stroke rate ratios with 95% confidence intervals (CIs).
RESULTS
We identified 258 806 patients with an MI and 1 244 773 individuals from the general population. For patients with MI, the cumulative stroke risks after 1 to 30 years were 12.6% for ischemic stroke, 1.2% for ICH, and 0.24% for SAH. During the first 30 days after MI, the adjusted stroke rate ratio was 30-fold increased for ischemic stroke (31.9; 95% CI, 28.4-35.8), 20-fold for ICH (21.8; 95% CI, 16.6-28.5), and 15-fold for SAH (16.6; 95% CI, 8.7-32.0). The adjusted stroke rate ratio remained increased during 31 to 365 days (3-fold for ischemic stroke, 2-fold for ICH, and 1.5-fold for SAH). During the ensuing 1 to 30 years, the risks remained increased for ischemic stroke (1.6; 95% CI, 1.6-1.6) but decreased to near unity for ICH (1.1; 95% CI, 1.0-1.2) and SAH (1.1; 95% CI, 0.94-1.2).
CONCLUSIONS
MI was a risk factor for all stroke subtypes during the first year of follow-up, but only for ischemic stroke thereafter.
背景与目的
心肌梗死（MI）后生存率的提高使得MI后发生卒中风险的患者数量增加。我们研究了MI患者与普通人群相比发生缺血性卒中、脑出血（ICH）和蛛网膜下腔出血（SAH）的风险。
方法
我们使用丹麦医疗登记系统进行了一项全国性的基于人群的队列研究。在1980年至2009年期间，我们确定了所有首次住院诊断为MI的患者，并形成了一个性别和年龄匹配的对照队列。我们计算了累积卒中风险，并调整了卒中率比及95%置信区间（CIs）。
结果
我们确定了258806例MI患者和1244773例普通人群个体。对于MI患者，1至30年后缺血性卒中的累积风险为12.6%，ICH为1.2%，SAH为0.24%。在MI后的前30天，缺血性卒中的调整卒中率比增加了30倍（31.9；95%CI，28.4 - 35.8），ICH增加了20倍（21.8；95%CI，16.6 - 28.5），SAH增加了15倍（16.6；95%CI，8.7 - 32.0）。在31至365天期间，调整卒中率比仍然增加（缺血性卒中为3倍，ICH为2倍，SAH为1.5倍）。在随后的1至30年中，缺血性卒中风险仍然增加（1.6；95%CI，1.6 - 1.6），但ICH（1.1；95%CI，1.0 - 1.2）和SAH（1.1；95%CI，0.94 - 1.2）降至接近1。
结论
MI在随访的第一年是所有卒中亚型的危险因素，但此后仅为缺血性卒中的危险因素。
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