Li Fen, Chen Yuqian, Hong Lan, Zhu Bifan, Chen Duo, Qin Xinyu, Gao Guangfeng, Xu Jianhua, Cheng Xin, Dong Qiang, Jin Chunlin, Fang Kun
Department of Health Policy Research, Shanghai Health Development Research Center, Shanghai, China.
Department of Neurology, Huashan Hospital Affiliated to Fudan University, Shanghai, China.
Ann Transl Med. 2021 Sep;9(17):1363. doi: 10.21037/atm-21-1971.
The stroke screening survey (SSS) is an essential strategy for stroke prevention. However, previous studies rarely discussed the effect of SSS on the acute phase treatment procedure for acute ischemic stroke (AIS) and the long-term prognosis outcomes. This study aims to investigate the effect of SSS on intravenous thrombolysis and long-term outcomes in AIS patients.
The stroke patients included were collected from Jiading Residences Community Health Records and Shanghai Stroke Service System database, from January 2017 to December 2019. Patients were divided into two groups, according to whether they have been screened before the event (onset and death). Demographic characteristics and treatment information of patients in the two groups were compared by the Mann-Whitney test and Chi-square test. The demographic differences between groups were adjusted with Propensity Score Matching (PSM) to evaluate the effect of SSS on door-to-needle time (DNT). The Kaplan-Meier survival curve with a log-rank test and multiple Cox regression model were used to evaluate the effect of SSS on long-term lifetime.
A total of 1,236 patients with AIS were collected, including 468 (37.86%) female, 126 (10.19%) patients with intravenous thrombolysis, 241 (23.30%) patients died from all-cause mortality by January 8, 2020. A total of 124 (10.03%) patients have been screened before AIS onset, and 261 (21.17%) patients had undergone SSS after AIS onset. The baseline information indicated that patients with previous screening were older than the patients without at the time of onset [75 (70, 83) . 73 (65, 82), P=0.017], as well as more likely to have a history of hypertension (90.32% . 78.51%, P=0.002) and diabetes (50.00% . 25.81%, P<0.001). PSM results showed that patients with previous screening were associated with less severe onset situation [3 (1, 9) 3 (1, 5), P=0.001] and shorter DNT [30 (24, 49) . 44 (31.5, 49), P=0.037] when compared to patients without. Additionally, patients with SSS had a lower hazard ratio of 0.567 (95% CI: 0.380-0.847, P=0.006) on all-cause mortality.
For AIS patients, the SSS is associated with less severe onset situation, shorter DNT, and longer long-term lifetime.
卒中筛查调查（SSS）是预防卒中的一项重要策略。然而，以往的研究很少讨论SSS对急性缺血性卒中（AIS）急性期治疗流程以及长期预后结果的影响。本研究旨在调查SSS对AIS患者静脉溶栓及长期预后的影响。
纳入的卒中患者收集自2017年1月至2019年12月的嘉定居民社区健康记录和上海卒中服务系统数据库。根据患者在事件（发病和死亡）前是否接受过筛查，将患者分为两组。两组患者的人口统计学特征和治疗信息通过Mann-Whitney检验和卡方检验进行比较。采用倾向得分匹配（PSM）对组间的人口统计学差异进行调整，以评估SSS对门到针时间（DNT）的影响。使用Kaplan-Meier生存曲线结合对数秩检验和多因素Cox回归模型来评估SSS对长期生存的影响。
共收集到1236例AIS患者，其中女性468例（37.86%），126例（10.19%）接受静脉溶栓治疗，截至2020年1月8日，241例（23.30%）患者因各种原因死亡。共有124例（10.03%）患者在AIS发病前接受过筛查，261例（21.17%）患者在AIS发病后接受了SSS。基线信息表明，既往接受过筛查的患者在发病时年龄大于未接受筛查的患者[75（70，83）. 73（65，82），P = 0.017]，同时更有可能有高血压病史（90.32%. 78.51%，P = 0.002）和糖尿病史（50.00%. 25.81%，P < 0.001）。PSM结果显示，与未接受筛查的患者相比，既往接受过筛查的患者发病情况较轻[3（1，9） 3（1，5），P = 0.001]，DNT较短[30（24，49）. 44（31.5，49），P = 0.037]。此外，接受SSS的患者全因死亡的风险比为0.567（95%CI：0.380 - 0.847，P = 0.006）。
对于AIS患者，SSS与较轻的发病情况、较短的DNT以及较长的长期生存期相关。
