轻度卒中或高危短暂性脑缺血发作后的一年结局：韩国多中心卒中登记分析
One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis.
作者信息
Park Hong-Kyun, Kim Beom Joon, Han Moon-Ku, Park Jong-Moo, Kang Kyusik, Lee Soo Joo, Kim Jae Guk, Cha Jae-Kwan, Kim Dae-Hyun, Nah Hyun-Wook, Park Tai Hwan, Park Sang-Soon, Lee Kyung Bok, Lee Jun, Hong Keun-Sik, Cho Yong-Jin, Lee Byung-Chul, Yu Kyung-Ho, Oh Mi-Sun, Kim Joon-Tae, Choi Kang-Ho, Kim Dong-Eog, Ryu Wi-Sun, Choi Jay Chol, Johansson Saga, Lee Su Jin, Lee Won Hee, Lee Ji Sung, Lee Juneyoung, Bae Hee-Joon
机构信息
From the Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (H.-K.P., B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Eulji General Hospital (J.-M.P., K.K.) and Department of Neurology, Eulji University Hospital (S.J.L., J.G.K.), Eulji University, Daejeon, Korea; Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.); Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.); Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Korea (J.C.C.); Global Medical Affairs, AstraZeneca Gothenburg, Mölndal, Sweden (S.J.); Medical Department, AstraZeneca Korea, Seoul (S.J.L., W.H.L.); Clinical Research Center, ASAN Medical Center, Seoul, Korea (J.S.L.); and Department of Biostatistics, Korea University College of Medicine, Seoul (J.L.).
出版信息
Stroke. 2017 Nov;48(11):2991-2998. doi: 10.1161/STROKEAHA.117.018045. Epub 2017 Oct 3.
BACKGROUND AND PURPOSE
Patients with minor ischemic stroke or transient ischemic attack are at high risk of recurrent stroke and vascular events, which are potentially disabling or fatal. This study aimed to evaluate contemporary subsequent vascular event risk after minor ischemic stroke or transient ischemic attack in Korea.
METHODS
Patients with minor ischemic stroke or high-risk transient ischemic attack admitted within 7 days of symptom onset were identified from a Korean multicenter stroke registry database. We estimated 3-month and 1-year event rates of the primary outcome (composite of stroke recurrence, myocardial infarction, or all-cause death), stroke recurrence, a major vascular event (composite of stroke recurrence, myocardial infarction, or vascular death), and all-cause death and explored differences in clinical characteristics and event rates according to antithrombotic strategies at discharge.
RESULTS
Of 9506 patients enrolled in this study, 93.8% underwent angiographic assessment and 72.7% underwent cardiac evaluations; 25.1% had symptomatic stenosis or occlusion of intracranial arteries. At discharge, 95.2% of patients received antithrombotics (antiplatelet polytherapy, 37.1%; anticoagulation, 15.3%) and 86.2% received statins. The 3-month cumulative event rate was 5.9% for the primary outcome, 4.3% for stroke recurrence, 4.6% for a major vascular event, and 2.0% for all-cause death. Corresponding values at 1 year were 9.3%, 6.1%, 6.7%, and 4.1%, respectively. Patients receiving nonaspirin antithrombotic strategies or no antithrombotic agent had higher baseline risk profiles and at least 1.5× higher event rates for clinical event outcomes than those with aspirin monotherapy.
CONCLUSIONS
Contemporary secondary stroke prevention strategies based on thorough diagnostic evaluation may contribute to the low subsequent vascular event rates observed in real-world clinical practice in Korea.
背景与目的
轻度缺血性卒中或短暂性脑缺血发作患者复发卒中及血管事件的风险较高，这些事件可能导致残疾或死亡。本研究旨在评估韩国轻度缺血性卒中或短暂性脑缺血发作后当代后续血管事件风险。
方法
从韩国多中心卒中登记数据库中识别出症状发作7天内入院的轻度缺血性卒中或高危短暂性脑缺血发作患者。我们估计了主要结局（卒中复发、心肌梗死或全因死亡的复合结局）、卒中复发、主要血管事件（卒中复发、心肌梗死或血管性死亡的复合结局）及全因死亡的3个月和1年事件发生率，并探讨了出院时抗栓策略在临床特征和事件发生率方面的差异。
结果
本研究纳入的9506例患者中，93.8%接受了血管造影评估，72.7%接受了心脏评估；25.1%有颅内动脉症状性狭窄或闭塞。出院时，95.2%的患者接受了抗栓治疗（抗血小板联合治疗，37.1%；抗凝治疗，15.3%），86.2%的患者接受了他汀类药物治疗。主要结局的3个月累积事件发生率为5.9%，卒中复发为4.3%，主要血管事件为4.6%，全因死亡为2.0%。1年时的相应值分别为9.3%、6.1%、6.7%和4.1%。接受非阿司匹林抗栓策略或未接受抗栓药物治疗的患者基线风险特征更高，临床事件结局的事件发生率比接受阿司匹林单药治疗的患者至少高1.5倍。
结论
基于全面诊断评估的当代二级卒中预防策略可能有助于韩国实际临床实践中观察到的较低后续血管事件发生率。
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