Nelson Sarah, Cloonan Lisa, Kanakis Allison S, Fitzpatrick Kaitlin M, Shideler Kelsey I, Perilla Adriana S, Furie Karen L, Rost Natalia S
J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts.
J Stroke Cerebrovasc Dis. 2016 Oct;25(10):2519-25. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.032. Epub 2016 Jul 18.
Aspirin is known to reduce stroke risk; however, its role in reducing severity of ischemic syndrome is not clear. We sought to investigate the relationship between antecedent aspirin use and stroke severity in patients presenting with acute ischemic stroke (AIS).
We retrospectively analyzed a prospectively collected database of consecutive AIS patients presenting to our center. Clinical characteristics (including antecedent aspirin use), imaging findings, and laboratory data were assessed in association with presenting stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS). Logistic regression models were used to determine univariate and multivariate predictors of baseline NIHSS.
Of the 610 AIS patients with admission brain magnetic resonance imaging available for volumetric analysis of acute infarct size, 241 (39.5%) used aspirin prior to stroke onset. Antecedent aspirin use (P = .0005), history of atrial fibrillation (P < .0001), acute infarct volume (P < .0001), initial systolic blood pressure (P = .041), admission glucose level (P = .0027), and stroke subtype (P < .0001) were associated with presenting stroke severity in univariate analysis. Antecedent aspirin use (P < .0001), history of atrial fibrillation (P < .0002), acute infarct volume (P < .0001), systolic blood pressure (P = .038), and glucose level (P = .0095) remained independent predictors of NIHSS in multivariable analysis.
Antecedent aspirin use was independently associated with milder presenting stroke severity, even after accounting for acute infarct volume. While the underlying biology of this apparent protective relationship requires further study, patients at high risk of stroke may benefit from routine aspirin use.
已知阿司匹林可降低中风风险；然而，其在降低缺血综合征严重程度方面的作用尚不清楚。我们试图研究急性缺血性中风（AIS）患者既往使用阿司匹林与中风严重程度之间的关系。
我们回顾性分析了前瞻性收集的连续就诊于我们中心的AIS患者数据库。评估临床特征（包括既往阿司匹林使用情况）、影像学检查结果和实验室数据，并将其与美国国立卫生研究院中风量表（NIHSS）测量的中风严重程度相关联。采用逻辑回归模型确定基线NIHSS的单因素和多因素预测因素。
在610例有入院脑磁共振成像可用于急性梗死灶体积分析的AIS患者中，241例（39.5%）在中风发作前使用过阿司匹林。单因素分析显示，既往阿司匹林使用情况（P = 0.0005）、房颤病史（P < 0.0001）、急性梗死灶体积（P < 0.0001）、初始收缩压（P = 0.041）、入院血糖水平（P = 0.0027）和中风亚型（P < 0.0001）与中风严重程度相关。多因素分析显示，既往阿司匹林使用情况（P < 0.0001）、房颤病史（P < 0.0002）、急性梗死灶体积（P < 0.0001）、收缩压（P = 0.038）和血糖水平（P = 0.0095）仍是NIHSS的独立预测因素。
即使在考虑急性梗死灶体积后，既往阿司匹林使用情况仍与较轻的中风严重程度独立相关。虽然这种明显保护关系的潜在生物学机制需要进一步研究，但中风高危患者可能从常规使用阿司匹林中获益。
