1 Joinville Stroke Registry, Joinville, Brazil.
2 University of Joinville Region, Joinville, Brazil.
Int J Stroke. 2019 Jul;14(5):491-499. doi: 10.1177/1747493018806197. Epub 2018 Oct 9.
Studies regarding long-term outcomes of ischemic stroke subtypes are scarce in low- and middle-income countries. We aimed to measure the five-year prognosis of ischemic stroke subtypes in Joinville, Brazil.
All first-ever ischemic strokes that occurred in Joinville in 2010 were followed-up for five years.
We included 334 ischemic stroke patients. Over five years, 156 died, 51 had a recurrent stroke, and 128 were free of recurrent stroke. The overall cumulative risk of death was 17% (95% CI, 13% to 22%) at 30 days and 47% (95% CI, 41% to 52%) after five years. Undetermined with incomplete investigation ischemic stroke had a significantly worse survival probability (β -4.91; 95% CI, -6.31 to -3.50; < 0.001), followed by cardioembolic ischemic stroke (β -3.07; 95% CI, -4.32 to -1.83; < 0.001) and large artery disease ischemic stroke (β -1.95; 95% CI, -3.30 to -0.60; = 0.005). The survival probability of undetermined with negative investigation or cryptogenic ischemic stroke did not differ significantly from small artery disease ischemic stroke (β -1.022; 95% CI, -3.37 to -1.43; = 0.414). The five-year mortality for small artery disease ischemic stroke was 30% (95% CI, 22% to 39%) and 47% (95% CI, 35% to 60%) for large artery ischemic stroke. The risk of stroke recurrence was 2% in the first year and 5% in the second year. The proportion of disability among survivors in the first month ranged from 8% (95% CI, 3-15) for small artery disease ischemic stroke to 40% (95% CI, 30-52) for cardioembolic ischemic stroke patients.
Cardioembolic and undetermined with incomplete investigation ischemic stroke sub-types have a poor long-term prognosis. An alarming finding was that our patients with both small and large artery ischemic stroke had higher five-year mortality rates compared with subjects from high-income countries.
在中低收入国家，关于缺血性卒中亚型的长期预后的研究较少。本研究旨在评估巴西若因维莱市缺血性卒中亚型的 5 年预后。
本研究纳入了 2010 年在若因维莱市首次发生的所有缺血性卒中患者，并对其进行了为期 5 年的随访。
本研究共纳入了 334 例缺血性卒中患者。5 年内，共有 156 例患者死亡，51 例患者复发卒中，128 例患者无复发卒中。发病后 30 天的总体累积死亡率为 17%（95%CI，13%22%），5 年后为 47%（95%CI，41%52%）。未明确病因且检查不完整的缺血性卒中患者的生存概率显著降低（β=-4.91；95%CI，-6.31-3.50； < 0.001），其次是心源性栓塞性缺血性卒中（β=-3.07；95%CI，-4.32-1.83； < 0.001）和大动脉粥样硬化性缺血性卒中（β=-1.95；95%CI，-3.30-0.60； = 0.005）。未明确病因且检查结果阴性或隐源性缺血性卒中患者的生存概率与小动脉疾病性缺血性卒中患者相比无显著差异（β=-1.022；95%CI，-3.37-1.43； = 0.414）。小动脉疾病性缺血性卒中患者的 5 年死亡率为 30%（95%CI，22%39%），大动脉粥样硬化性缺血性卒中患者的 5 年死亡率为 47%（95%CI，35%60%）。卒中复发的风险在第一年为 2%，第二年为 5%。发病后第一个月，幸存者的残疾比例在小动脉疾病性缺血性卒中患者中为 8%（95%CI，315），在心源性栓塞性缺血性卒中患者中为 40%（95%CI，3052）。
心源性栓塞性和未明确病因且检查不完整的缺血性卒中亚型患者具有较差的长期预后。一个令人震惊的发现是，我们的小动脉和大动脉缺血性卒中患者的 5 年死亡率均高于高收入国家的患者。
