Timm Fanny P, Houle Timothy T, Grabitz Stephanie D, Lihn Anne-Louise, Stokholm Janne B, Eikermann-Haerter Katharina, Nozari Ala, Kurth Tobias, Eikermann Matthias
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Department of Anesthesiology, University of Copenhagen, Herlev Hospital, Copenhagen, Denmark.
BMJ. 2017 Jan 10;356:i6635. doi: 10.1136/bmj.i6635.
To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate.
Prospective hospital registry study.
Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014.
124 558 surgical patients (mean age 52.6 years; 54.5% women).
The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location.
10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41).
Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative ischemic stroke.
评估偏头痛患者围手术期缺血性卒中风险是否增加，以及这是否会导致住院再入院率升高。
前瞻性医院登记研究。
2007年1月至2014年8月间的马萨诸塞州总医院及其两个卫星院区。
124558例手术患者（平均年龄52.6岁；54.5%为女性）。
主要结局是有或无偏头痛及偏头痛先兆的患者在术后30天内发生的围手术期缺血性卒中。次要结局是术后30天内再次入院。探索性结局包括出院后卒中及神经解剖学卒中部位分层。
10179例（8.2%）患者有任何偏头痛诊断，其中1278例（12.6%）有偏头痛先兆，8901例（87.4%）有偏头痛但无先兆。771例（0.6%）围手术期缺血性卒中发生在术后30天内。与无偏头痛患者相比，偏头痛患者围手术期缺血性卒中风险增加（校正比值比1.75，95%置信区间1.39至2.21）。有偏头痛先兆的患者风险（校正比值比2.61，1.59至4.29）高于无偏头痛先兆的患者（1.62，1.26至2.09）。每1000例手术患者围手术期缺血性卒中的预测绝对风险为2.4（2.1至2.8）例。每1000例有任何偏头痛诊断的患者中，这一风险增至4.3（3.2至5.3）例，无偏头痛先兆的患者为3.9（2.9至5.0）例，有偏头痛先兆的患者为6.3（3.2至9.5）例。偏头痛患者出院后30天内再次入院率较高（校正比值比1.31，1.22至1.41）。
有偏头痛病史的手术患者围手术期缺血性卒中风险增加，30天住院再入院率升高。围手术期缺血性卒中风险评估中应考虑偏头痛因素。
