急性缺血性脑卒中后心肌梗死：发生率、死亡率和危险因素。
Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors.
机构信息
Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK.
出版信息
Acta Neurol Scand. 2019 Sep;140(3):219-228. doi: 10.1111/ane.13135. Epub 2019 Jun 17.
OBJECTIVES
To determine the risk factor profiles associated with post-acute ischaemic stroke (AIS) myocardial infarction (MI) over long-term follow-up.
METHODS
This observational study includes prospectively identified AIS patients (n = 9840) admitted to a UK regional centre between January 2003 and December 2016 (median follow-up: 4.72 years). Predictors of post-stroke MI during follow-up were examined using logistic and Cox regression models for in-hospital and post-discharge events, respectively. MI incidence was determined using a competing risk non-parametric estimator. The influence of post-stroke MI on mortality was examined using Cox regressions.
RESULTS
Mean age (SD) of study participants was 77.3 (12.2) years (48% males). Factors associated with in-hospital MI (OR [95% CI]) were increasing blood glucose (1.80 [1.17-2.77] per 10 mmol/L), total leucocyte count (1.25 [1.01-1.54] per 10 × 10 /L) and CRP (1.05 [1.02-1.08] per 10 mg/L increase). Age (HR [95% CI] = 1.03 [1.01-1.06]), coronary heart disease (1.59 [1.01-2.50]), chronic kidney disease (2.58 [1.44-4.63]) and cancers (1.76 [1.08-2.89]) were associated with incident MI between discharge and one-year follow-up. Age (1.02 [1.00-1.03]), diabetes (1.96 [1.38-2.65]), congestive heart failure (2.07 [1.44-2.99]), coronary heart disease (1.81 [1.31-2.50]), hypertension [1.86 (1.24-2.79)] and peripheral vascular disease (2.25 [1.40-3.63]) were associated with incident MI between 1 and 5 years after discharge. Diabetes (2.01 [1.09-3.72]), hypertension (3.69 [1.44-9.45]) and peripheral vascular disease (2.46 [1.02-5.98]) were associated with incident MI between 5 and 10 years after discharge. Cumulative MI incidence over 10 years was 5.4%. MI during all follow-up periods (discharge-1, 1-5, 5-10 years) was associated with increased risk of death (respective HR [95% CI] = 3.26 [2.51-4.15], 1.96 [1.58-2.42] and 1.92 [1.26-2.93]).
CONCLUSIONS
In conclusion, prognosis is poor in post-stroke MI. We highlight a range of potential areas to focus preventative efforts.
目的
确定与长期随访后急性缺血性脑卒中（AIS）心肌梗死（MI）相关的风险因素特征。
方法
本观察性研究纳入了 2003 年 1 月至 2016 年 12 月期间在英国一个地区中心住院的 AIS 患者（n=9840）（中位随访时间：4.72 年）。使用逻辑和 Cox 回归模型分别对住院期间和出院后事件的卒中后 MI 的预测因素进行了检验。使用竞争风险非参数估计器确定 MI 的发生率。使用 Cox 回归检验卒中后 MI 对死亡率的影响。
结果
研究参与者的平均年龄（SD）为 77.3（12.2）岁（48%为男性）。与住院期间 MI 相关的因素（OR [95%CI]）为血糖升高（每 10mmol/L 增加 1.80 [1.17-2.77]）、总白细胞计数（每 10×10/L 增加 1.25 [1.01-1.54]）和 CRP（每 10mg/L 增加 1.05 [1.02-1.08]）。年龄（HR [95%CI] = 1.03 [1.01-1.06]）、冠心病（1.59 [1.01-2.50]）、慢性肾脏病（2.58 [1.44-4.63]）和癌症（1.76 [1.08-2.89]）与出院后至一年随访期间的 MI 事件相关。年龄（1.02 [1.00-1.03]）、糖尿病（1.96 [1.38-2.65]）、充血性心力衰竭（2.07 [1.44-2.99]）、冠心病（1.81 [1.31-2.50]）、高血压[1.86（1.24-2.79）]和外周血管疾病（2.25 [1.40-3.63]）与出院后 1-5 年期间的 MI 事件相关。糖尿病（2.01 [1.09-3.72]）、高血压（3.69 [1.44-9.45]）和外周血管疾病（2.46 [1.02-5.98]）与出院后 5-10 年期间的 MI 事件相关。10 年内 MI 的累积发生率为 5.4%。所有随访期间（出院-1 年、1-5 年、5-10 年）的 MI 与死亡风险增加相关（相应的 HR [95%CI]分别为 3.26 [2.51-4.15]、1.96 [1.58-2.42]和 1.92 [1.26-2.93]）。
结论
总之，卒中后 MI 的预后较差。我们强调了一系列可能需要预防的潜在领域。
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