From the University of Pennsylvania (B.C., D.K.G., S.E.K.), Philadelphia; AstraZeneca (M.K., H.D., P.L.), Mölndal, Sweden; Bichat Hospital (P.A.), Paris, France; and University of Texas-Austin (S.C.J.).
Neurology. 2019 Aug 13;93(7):e708-e716. doi: 10.1212/WNL.0000000000007936. Epub 2019 Jul 11.
To examine factors associated with disability following TIA and minor stroke, including poststroke complications such as stroke recurrence, major bleeding, and other adverse medical events.
The SOCRATES trial randomized patients with TIA/minor stroke (NIH Stroke Scale [NIHSS] score ≤5) within 24 hours of onset. We performed a post hoc analysis of factors associated with disability (modified Rankin Scale [mRS] score >1). TIA and minor stroke were analyzed separately. Patients with premorbid mRS >0 were excluded.
At 90 days, 687/3,663 (19%) patients with stroke were disabled; for TIA, 122/2,384 (5%) were disabled. In multivariate analyses, age, diabetes, and NIHSS were associated with disability in the stroke cohort, and age with disability in the TIA cohort. Postrandomization events (recurrent stroke, myocardial infarction, major bleeding, serious adverse events) were strongly associated with disability in both cohorts (stroke cohort: odds ratio [OR] 5.6, 95% confidence interval [CI] 4.5-6.9; TIA cohort: OR 14.8, 95% CI 9.9-22.0). Of the TIA patients who ended up disabled, 65% experienced a postrandomization event; for stroke patients who ended up disabled, 39% had a postrandomization event. Disability increased linearly with NIHSS score ( < 0.0001) and was greater in those with limb weakness ( < 0.0001).
After TIA and minor stroke, subsequent stroke and medical complications are strongly associated with disability. In addition, even within a low range of baseline scores, the NIHSS is a powerful predictor of disability in minor stroke patients, with items scoring limb weakness particularly associated with subsequent disability.
探讨与 TIA 和小卒中后残疾相关的因素，包括卒中后并发症，如卒中复发、大出血和其他不良医疗事件。
SOCRATES 试验将发病 24 小时内的 TIA/小卒中患者（NIH 卒中量表[NIHSS]评分≤5）随机分组。我们对与残疾（改良 Rankin 量表[mRS]评分>1）相关的因素进行了事后分析。分别分析 TIA 和小卒中。排除发病前 mRS>0 的患者。
90 天时，3663 例卒中患者中有 687 例（19%）残疾；2384 例 TIA 患者中有 122 例（5%）残疾。多变量分析显示，年龄、糖尿病和 NIHSS 与卒中组残疾相关，年龄与 TIA 组残疾相关。随机分组后事件（复发性卒中、心肌梗死、大出血、严重不良事件）与两组患者的残疾均密切相关（卒中组：比值比[OR]5.6，95%置信区间[CI]4.5-6.9；TIA 组：OR 14.8，95%CI 9.9-22.0）。TIA 患者中最终残疾者中有 65%发生了随机分组后事件；卒中患者中最终残疾者中有 39%发生了随机分组后事件。残疾与 NIHSS 评分呈线性相关（<0.0001），且伴肢体无力的患者残疾程度更严重（<0.0001）。
TIA 和小卒中后，再次发生卒中及医疗并发症与残疾密切相关。此外，即使在基线评分较低的范围内，NIHSS 也是小卒中患者残疾的有力预测因素，其中与肢体无力相关的评分项目尤其与随后的残疾相关。
