Akijian Layan, Ní Chróinín Danielle, Callaly Elizabeth, Hannon Niamh, Marnane Michael, Merwick Áine, Sheehan Órla, Hayden Derek, Horgan Gillian, Duggan Joseph, Kyne Lorraine, O'Rourke Killian, Murphy Sean, Dolan Eamon, Williams David, Kelly Peter J
1 Neurovascular Unit for Translational and Therapeutics Research, Mater Misericordiae University Hospital/University College Dublin, Dublin, Ireland.
2 Department of Geriatric and Stroke Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Int J Stroke. 2017 Jan;12(1):96-104. doi: 10.1177/1747493016669851. Epub 2016 Oct 3.
Background Few studies have directly compared stroke recurrence rates after stroke and transient ischemic attack, and the risk factors underlying early recurrence are poorly understood. We aimed to investigate risk factors for recurrent stroke after first stroke and transient ischemic attack in a population-based study. Methods The North Dublin Population Stroke Study applied multiple overlapping hot and cold pursuit methods, to ascertain hospital- and community-treated stroke and transient ischemic attack patients over a 12-month period. Inclusion criteria were: (1) Stroke-physician confirmed transient ischemic attack/ischemic stroke; (2) first-stroke/transient ischemic attack event within the ascertainment period. Patients were prospectively followed at 72 h, 7, 28 and 90 days. Results A total of 584 patients met eligibility criteria (172 transient ischemic attack, 412 stroke). More transient ischemic attack than stroke patients presented to medical attention with recurrent stroke (8.24% vs. 0.24%, p = 0.0002). Recurrent stroke was more common after transient ischemic attack than index stroke at each time-interval (at 72 h, 4.07% vs. 1.23%, p = 0.03; at 90 days, 13.45% vs. 5.72%, p = 0.002). Stroke recurrence at 90 days was also associated with delay seeking medical attention after the index event (OR 3.2, p = 0.001), delayed anti-platelet (OR 2.8, p = 0.001) and statin (OR 2.4, p = 0.009) treatment, carotid stenosis/occlusion (OR 2.4, p = 0.008). On multivariable analysis, transient ischemic attack as index event (adjusted OR 2.3, p = 0.02), delayed statin treatment (OR 2.5, p = 0.02), and carotid stenosis/occlusion (OR 2.4, p = 0.02) were independent predictors of 90-day recurrent stroke. Conclusion A combination of pathophysiological and behavioral factors was associated with early stroke recurrence risk. Improved public awareness to reduce delays to self-referral for transient ischemic attack symptoms is needed.
很少有研究直接比较中风和短暂性脑缺血发作后的中风复发率，且对早期复发的潜在危险因素了解甚少。我们旨在通过一项基于人群的研究来调查首次中风和短暂性脑缺血发作后复发性中风的危险因素。方法：北都柏林人群中风研究采用多种重叠的冷热追踪方法，以确定在12个月期间接受医院和社区治疗的中风和短暂性脑缺血发作患者。纳入标准为：（1）经中风专科医生确诊的短暂性脑缺血发作/缺血性中风；（2）在确定期间内首次发生中风/短暂性脑缺血发作事件。对患者在72小时、7天、28天和90天时进行前瞻性随访。结果：共有584名患者符合入选标准（172例短暂性脑缺血发作，412例中风）。因复发性中风就医的短暂性脑缺血发作患者比中风患者更多（8.24%对0.24%，p = 0.0002）。在每个时间间隔，短暂性脑缺血发作后复发性中风比首次中风更常见（72小时时，4.07%对1.23%，p = 0.03；90天时，13.45%对5.72%，p = 0.002）。90天时的中风复发也与首次事件后延迟就医（比值比3.2，p = 0.001）、延迟抗血小板治疗（比值比2.8，p = 0.001）和他汀类药物治疗（比值比2.4，p = 0.009）、颈动脉狭窄/闭塞（比值比2.4，p = 0.008）有关。多变量分析显示，以短暂性脑缺血发作为首次事件（校正比值比2.3，p = 0.02）、延迟他汀类药物治疗（比值比2.5，p = 0.02）和颈动脉狭窄/闭塞（比值比2.4，p = 0.02）是90天复发性中风的独立预测因素。结论：病理生理因素和行为因素的组合与早期中风复发风险相关。需要提高公众意识，以减少因短暂性脑缺血发作症状而延迟自我转诊的情况。
