Turan Tanya N, Nizam Azhar, Lynn Michael J, Egan Brent M, Le Ngoc-Anh, Lopes-Virella Maria F, Hermayer Kathie L, Harrell Jamie, Derdeyn Colin P, Fiorella David, Janis L Scott, Lane Bethany, Montgomery Jean, Chimowitz Marc I
From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD.
Neurology. 2017 Jan 24;88(4):379-385. doi: 10.1212/WNL.0000000000003534. Epub 2016 Dec 21.
The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocol-driven intensive management of multiple risk factors. In this prespecified analysis, we aimed to investigate the relationship between risk factor control during follow-up and outcome of patients in the medical arm of SAMMPRIS.
Data from SAMMPRIS participants in the medical arm (n = 227) were analyzed. Risk factors were recorded at baseline, 30 days, 4 months, and then every 4 months for a mean follow-up of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target.
Participants who were out of target for systolic blood pressure and physical activity, as well as those with higher mean low-density lipoprotein cholesterol and non-high-density lipoprotein, were more likely to have a recurrent vascular event (stroke, myocardial infarction, or vascular death) at 3 years compared to those who had good risk factor control. In the multivariable analysis, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death (odds ratio 0.6, confidence interval 0.4-0.8).
Raised blood pressure, cholesterol, and physical inactivity should be aggressively treated in patients with intracranial atherosclerosis to prevent future vascular events. Physical activity, which has not received attention in stroke prevention trials, was the strongest predictor of a good outcome in the medical arm in SAMMPRIS.
NCT00576693.
颅内狭窄支架置入与积极药物预防复发性卒中（SAMMPRIS）研究是首个纳入对多种危险因素进行方案驱动的强化管理的卒中预防试验。在这项预先设定的分析中，我们旨在研究SAMMPRIS药物治疗组患者随访期间危险因素控制与预后之间的关系。
对SAMMPRIS药物治疗组的参与者（n = 227）的数据进行分析。在基线、30天、4个月时记录危险因素，然后每4个月记录一次，平均随访32个月。对于每位患者，将所有危险因素测量值进行平均，并按照是否达到目标分为两类。
与危险因素控制良好的患者相比，收缩压、体力活动未达目标的参与者，以及平均低密度脂蛋白胆固醇和非高密度脂蛋白水平较高的参与者在3年时更有可能发生复发性血管事件（卒中、心肌梗死或血管性死亡）。在多变量分析中，更多的体力活动降低了复发性卒中、心肌梗死或血管性死亡的可能性（比值比0.6，置信区间0.4 - 0.8）。
对于颅内动脉粥样硬化患者，应积极治疗血压升高、胆固醇升高和缺乏体力活动的情况，以预防未来的血管事件。体力活动在卒中预防试验中未受到关注，却是SAMMPRIS药物治疗组良好预后的最强预测因素。
NCT00576693。
