Serviço de Neurologia, Hospital Santo António-Centro Hospitalar do Porto, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
Int J Stroke. 2020 Apr;15(3):278-288. doi: 10.1177/1747493019830322. Epub 2019 Feb 8.
A decline in TIA incidence would be expected mirroring stroke trends, but patient's awareness of symptoms/signs, improved diagnostic procedures and changes in severity of vascular disease may raise TIA incidence. We aimed to estimate changes in TIA incidence and 30-day stroke risk in Portugal.
Data from two prospective community-based registers of first-ever TIA in 104,700 (1998-2000) and 118,232 (2009-2011) persons were collected using comprehensive case ascertainment methods. Incidence and stroke risk from TIA onset were compared using different inception cohorts. ABCD was used to stratified stroke risk.
Overall, 141 patients were included in 1998-2000 and 174 in 2009-2011. Crude annual incidence rate increased from 67 to 74/100,000 (IRR=1.12; 95% CI, 0.90-1.40), particularly in men under 65 years (IRR=1.79; 95% CI, 1.06-3.04). Male/female IRR increased from 1.20 (0.86-1.68) in 1998-2000 to 1.77 (1.31-2.39) in 2009-2011, after adjustment for age. Better control of vascular risk factors (VRFs) accounted for lower ABCD scores in 2009-2011. The 30-day stroke risk was similar in study periods (18.4% vs. 16.7%, > 0.7), decreasing from 16.1% to 8.2% ( < 0.042) excluding patients reporting TIA after stroke occurrence and from 12.2% to 4.0% ( < 0.011) further excluding patients who had stroke in ambulance/hospital. ABCD discriminated stroke risk only in 1998-2000; stroke severity decreased while posterior circulation stroke was more common in 2009-2011.
Despite a stable TIA incidence across periods, the risk increased in men compared to women. Better control of VRF accounted for lower ABCD scores and secondary prevention reduced stroke risk. Men under 65 years emerge as a preferential target for primary and secondary prevention.
预计 TIA 发病率的下降将与中风趋势相吻合，但患者对症状/体征的认识、诊断程序的改善以及血管疾病严重程度的变化可能会导致 TIA 发病率上升。我们旨在估计葡萄牙 TIA 发病率和 30 天内中风风险的变化。
使用全面的病例确定方法，收集了 104700 名（1998-2000 年）和 118232 名（2009-2011 年）首次发生 TIA 的两个前瞻性社区登记处的数据。使用不同的起始队列比较 TIA 发病时的发病率和中风风险。使用 ABCD 对中风风险进行分层。
总体而言，1998-2000 年有 141 名患者，2009-2011 年有 174 名患者。未经调整的年发病率从 67 例/100000 人增加到 74 例/100000 人（IRR=1.12；95%CI，0.90-1.40），尤其是在 65 岁以下的男性（IRR=1.79；95%CI，1.06-3.04）。1998-2000 年男性/女性 IRR 为 1.20（0.86-1.68），2009-2011 年调整年龄后为 1.77（1.31-2.39）。更好地控制血管危险因素（VRFs）导致 2009-2011 年 ABCD 评分降低。研究期间 30 天内中风风险相似（18.4%比 16.7%，>0.7），排除报告中风后发生 TIA 的患者后，风险从 16.1%降至 8.2%（<0.042），进一步排除在救护车/医院发生中风的患者后，风险从 12.2%降至 4.0%（<0.011）。ABCD 仅在 1998-2000 年区分中风风险；中风严重程度降低，而 2009-2011 年后循环中风更为常见。
尽管各时期 TIA 发病率稳定，但男性的风险较女性增加。更好地控制 VRF 可降低 ABCD 评分，二级预防可降低中风风险。65 岁以下的男性成为初级和二级预防的首选目标。
