Brigham and Women's Hospital (Department of Medicine) and Harvard Medical School, 75 Francis Street, Boston, MA, USA.
Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Hock Plaza Suite 1102, Durham, NC, USA.
Eur Heart J. 2018 Jul 1;39(25):2376-2386. doi: 10.1093/eurheartj/ehy036.
There is a paucity of data on the influence of diabetes on long-term outcomes after ischaemic stroke (IS). We assessed whether outcomes after IS differ between patients with and without diabetes.
Patients aged ≥65 years (n = 409 060) in Get With The Guidelines-Stroke (nationwide registry of stroke patients from 1690 sites in the USA) were followed for 3 years post-discharge. The outcomes of interest were mortality, cardiovascular and non-cardiovascular hospitalizations, heart failure (HF), and recurrence of IS/transient ischaemic attack (TIA). Patients with diabetes (29.6%) were younger and had more comorbidities. At 3 years post-discharge after IS, diabetes was associated with higher risks of adverse outcomes: all-cause mortality [cumulative incidence 46.0% vs. 44.2%, absolute difference (AD) 1.8%; adjusted hazard ratio (aHR) 1.24, 95% confidence interval 1.23-1.25], all-cause readmission (71.3% vs. 63.7%, AD 7.6%; aHR 1.22, 1.21-1.23), composite of mortality and all-cause readmission (84.1% vs. 79.3%, AD 4.8%; aHR 1.21, 1.20-1.22), composite of mortality and cardiovascular readmission (69.5% vs. 64.3%, AD 5.2%; aHR 1.19, 1.18-1.20), IS/TIA readmission (15.9% vs. 13.3%, AD 2.6%; aHR 1.18, 1.16-1.20), HF readmission (10.3% vs. 6.4%, AD 3.9%; aHR 1.60, 1.56-1.64), non-cardiovascular readmission (58.3% vs. 50.3%, AD 8.0%; aHR 1.28, 1.26-1.29), and non-IS/TIA readmission (67.6% vs. 59.7%, AD 7.9%; aHR 1.23, 1.22-1.25). Accounting for the initial severity of stroke using the National Institute of Health Stroke Scale as well as using propensity score matching method as a sensitivity analysis, did not modify the results.
Among older IS patients diabetes was associated with increased risks of death, cardiovascular and non-cardiovascular hospitalizations, HF, and IS/TIA recurrence.
关于糖尿病对缺血性脑卒中（IS）后长期预后的影响的数据较少。我们评估了 IS 患者中有无糖尿病对预后的影响是否不同。
在 Get With The Guidelines-Stroke（美国 1690 个地点的卒中患者的全国登记处）中，年龄≥65 岁（n=409060）的患者在出院后 3 年内进行随访。主要结局为死亡率、心血管和非心血管住院、心力衰竭（HF）和再发 IS/TIA。合并糖尿病（29.6%）的患者更年轻，且合并症更多。IS 后 3 年，糖尿病与更高的不良结局风险相关：全因死亡率[累积发生率 46.0% vs. 44.2%，绝对差值（AD）1.8%；调整后风险比（aHR）1.24，95%置信区间（CI）1.23-1.25]、全因再入院（71.3% vs. 63.7%，AD 7.6%；aHR 1.22，1.21-1.23）、全因死亡和再入院的复合终点（84.1% vs. 79.3%，AD 4.8%；aHR 1.21，1.20-1.22）、全因死亡和心血管再入院的复合终点（69.5% vs. 64.3%，AD 5.2%；aHR 1.19，1.18-1.20）、IS/TIA 再入院（15.9% vs. 13.3%，AD 2.6%；aHR 1.18，1.16-1.20）、HF 再入院（10.3% vs. 6.4%，AD 3.9%；aHR 1.60，1.56-1.64）、非心血管再入院（58.3% vs. 50.3%，AD 8.0%；aHR 1.28，1.26-1.29）和非 IS/TIA 再入院（67.6% vs. 59.7%，AD 7.9%；aHR 1.23，1.22-1.25）。使用国立卫生研究院卒中量表（National Institute of Health Stroke Scale）作为初始卒中严重程度的指标，以及使用倾向评分匹配法作为敏感性分析，结果均未改变。
在老年 IS 患者中，糖尿病与死亡、心血管和非心血管住院、HF 以及 IS/TIA 复发的风险增加相关。
