Cordonnier Charlotte, Lemesle Gilles, Casolla Barbara, Bic Matthieu, Caparros François, Lamblin Nicolas, Bauters Christophe
Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France.
Université de Lille, Inserm U1011, Institut Pasteur, CHU Lille, Department of Cardiology, Lille, France.
Eur Stroke J. 2018 Sep;3(3):272-280. doi: 10.1177/2396987318772684. Epub 2018 Apr 30.
There are limited data on cerebrovascular events in patients with stable coronary artery disease. To study the risk of cerebrovascular event, the relative proportion of ischaemic stroke and intracranial haemorrhage, and their prognostic factors in stable coronary artery disease are investigated.
The CORONOR registry prospectively recruited, between February 2010 and April 2011, 4184 unselected stable coronary artery disease outpatients. All events occurring during a five-year follow-up were adjudicated.
Ninety-six patients had an ischaemic stroke and 34 had an intracranial haemorrhage, reaching a cumulative incidence after five years of 3.2 (2.7-3.8)%. During the same period, 677 deaths and 170 myocardial infarctions (ST-elevation MI, = 55; non-ST-elevation MI, = 115) occurred. In elderly individuals, the number of cerebrovascular events was higher than that of myocardial infarctions and largely exceeded that of ST-elevation myocardial infarctions. Predictors of ischaemic stroke were: previous history of stroke (subhazard ratio (SHR)=3.16(1.95-5.14)), absence of statin therapy at inclusion (SHR = 2.45(1.47-4.10), increasing age (SHR = 1.45(1.16-1.82) per 10-year increase) and diabetes mellitus (SHR = 1.65(1.10-2.49)). Predictors of intracranial haemorrhage were: combination of vitamin K antagonists with an antiplatelet agent at inclusion (SHR = 5.41(2.49-11.75), single antiplatelet therapy as reference), and increasing age (SHR = 1.47(1.12-1.93) per 10-year increase).
In stable coronary artery disease patients, the brain deserves attention. In patients at high risk of ischaemic stroke, secondary prevention could be intensified. Our results raise awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants in stable coronary artery disease patients.
While improving the prevention of future vaso-occlusive events should be our ultimate goal in coronary artery disease patients, the net clinical benefit of our treatments should carefully be studied.
关于稳定型冠状动脉疾病患者脑血管事件的数据有限。为研究脑血管事件风险、缺血性卒中与颅内出血的相对比例及其在稳定型冠状动脉疾病中的预后因素展开调查。
CORONOR登记处于2010年2月至2011年4月前瞻性招募了4184例未经选择的稳定型冠状动脉疾病门诊患者。对五年随访期间发生的所有事件进行判定。
96例患者发生缺血性卒中，34例发生颅内出血，五年累积发病率为3.2（2.7 - 3.8）%。同期，发生677例死亡和170例心肌梗死（ST段抬高型心肌梗死55例；非ST段抬高型心肌梗死115例）。在老年个体中，脑血管事件数量高于心肌梗死，且大大超过ST段抬高型心肌梗死。缺血性卒中的预测因素为：既往卒中史（亚风险比（SHR）=3.16（1.95 - 5.14））、纳入时未接受他汀治疗（SHR = 2.45（1.47 - 4.10））、年龄增长（每增加10岁SHR = 1.45（1.16 - 1.82））和糖尿病（SHR = 1.65（1.10 - 2.49））。颅内出血的预测因素为：纳入时维生素K拮抗剂与抗血小板药物联合使用（SHR = 5.41（2.49 - 11.75），以单一抗血小板治疗为参照）以及年龄增长（每增加10岁SHR = 1.47（1.12 - 1.93））。
在稳定型冠状动脉疾病患者中，脑部值得关注。对于缺血性卒中高危患者，可强化二级预防。我们的结果提高了对稳定型冠状动脉疾病患者抗血小板药物与口服抗凝剂联合使用风险的认识。
虽然改善对冠状动脉疾病患者未来血管闭塞事件的预防应是我们的最终目标，但应仔细研究我们治疗的净临床获益。
