Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).
China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).
Stroke. 2021 Jun;52(6):2007-2015. doi: 10.1161/STROKEAHA.120.032424. Epub 2021 May 5.
Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD score.
We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD score (low risk, 0-3; moderate risk, 4-5; and high risk, 6-7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence.
Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200-2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042-1.687]) but not in the high-risk group (>0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group.
Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.
根据传统评分系统（如 ABCD 评分，基于五个因素的首字母：年龄、血压、临床特征、持续时间、糖尿病），影像学参数是否能独立预测低危小卒中和短暂性脑缺血发作（TIA）患者的卒中复发，目前尚不清楚。我们旨在评估 ABCD 评分分层的不同风险分层 TIA 或 MIS 患者的影像学参数与 1 年内卒中复发之间的相关性。
我们纳入了来自中国第三次国家卒中登记研究 III 的 TIA 和 MIS（NIHSS 评分≤3）患者的完整基线血管和脑影像学数据。患者根据 ABCD 评分分为不同风险组（低危，0-3；中危，4-5；高危，6-7）。主要结局为 1 年内卒中复发。多变量 Cox 比例风险回归模型用于评估影像学参数（大动脉狭窄、梗死数量）是否与卒中复发独立相关。
在纳入的 7140 例患者中，有 584 例患者在 1 年内发生卒中复发。根据 ABCD 评分，大动脉狭窄与低危（校正后风险比，1.746 [95%CI，1.200-2.540]）和中危组（校正后风险比，1.326 [95%CI，1.042-1.687]）患者的卒中复发风险较高相关，但在高危组中不相关（>0.05）。与无脑梗死患者相比，低危和中危组中急性多发梗死或单发梗死患者的卒中复发风险更高，但在高危组中则不然。
大动脉狭窄和梗死数量是 ABCD 评分分层的低危-中危 TIA 或 MIS 患者 1 年内卒中复发的独立预测因素，但在高危患者中则不然。这一发现强调了对 TIA 或 MIS 患者进行早期脑和血管影像学评估以进行风险分层的重要性。
