中国高龄缺血性卒中和短暂性脑缺血发作患者的临床特征和预后。

Clinical characteristics and prognosis in oldest old patients with ischaemic stroke or transient ischaemic attack in China.

机构信息

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Ann Palliat Med. 2022 Jul;11(7):2215-2224. doi: 10.21037/apm-21-2830. Epub 2022 Feb 28.

DOI:10.21037/apm-21-2830

PMID:35272470

Abstract

BACKGROUND

Limited data are available about the prognosis of ischaemic stroke or transient ischaemic attack (TIA) in oldest-old patients, especially in China. We aimed to describe the clinical characteristics and prognosis of oldest-old patients with ischaemic stroke or TIA in China.

METHODS

Patients with acute ischaemic stroke (AIS) or TIA were recruited between August 2015 and March 2018 in the Third China National Stroke Registry (CNSR-III). Clinical characteristics including demographic data, medical history, medication use and stroke aetiology, were obtained. The outcomes were one-year stroke recurrence, combined vascular events (stroke, myocardial infarction, and cardiovascular death), mortality, and poor functional outcome [modified Rankin scale (mRS) 3-6]. Oldest-old was defined as ≥80 years old. Clinical characteristics and prognosis were compared by different age groups (<65, 65-79, and ≥80 years). The association between age and prognosis was analysed using the multivariable Cox proportional hazards and logistic regression models.

RESULTS

A total of 15,166 patients with AIS or TIA were included in this study with 929 (6.13%) oldest-old patients. Oldest-old patients had a higher likelihood of cardioembolic stroke or comorbid cardiac disease than other age groups. When compared with patients aged <65 years, oldest-old patients had higher risk of one-year stroke recurrence [adjusted hazard ratio (HR) 1.36; 95% confidence interval (CI): 1.06-1.73, P=0.014], combined vascular events [adjusted HR, 1.42; 95% CI, 1.13-1.79, P=0.003], mortality [adjusted odds ratio (OR), 4.25; 95% CI: 2.99-6.04, P<0.001] and poor functional outcome (adjusted OR, 4.25; 95% CI: 3.40-5.33, P<0.001) with P for trends <0.001 among age groups.

CONCLUSIONS

Oldest-old patients differed from younger patients regarding clinical characteristics, stroke aetiology, and secondary preventive medication persistence with a poor clinical prognosis in China. Current information on profile of the oldest-old stroke patients is crucial to develop specific secondary prevention and treatment strategies.

摘要

背景

关于最年长的缺血性卒中和短暂性脑缺血发作（TIA）患者的预后数据有限，尤其是在中国。本研究旨在描述中国最年长的缺血性卒中和 TIA 患者的临床特征和预后。

方法

我们于 2015 年 8 月至 2018 年 3 月在第三次中国国家卒中登记研究（CNSR-III）中招募了急性缺血性卒中（AIS）或 TIA 患者。收集了包括人口统计学数据、既往病史、药物使用和卒中病因等临床特征。研究终点为 1 年卒中复发、复合血管事件（卒中、心肌梗死和心血管死亡）、死亡率和不良功能结局（改良 Rankin 量表[mRS] 3-6 分）。最年长的患者定义为年龄≥80 岁。通过不同年龄组（<65 岁、65-79 岁和≥80 岁）比较临床特征和预后。使用多变量 Cox 比例风险和逻辑回归模型分析年龄与预后的关系。

结果

本研究共纳入 15166 例 AIS 或 TIA 患者，其中 929 例（6.13%）为最年长的患者。与其他年龄组相比，最年长的患者更可能发生心源性卒中或合并心脏疾病。与<65 岁的患者相比，最年长的患者 1 年卒中复发风险更高[校正风险比（HR）1.36；95%置信区间（CI）：1.06-1.73，P=0.014]、复合血管事件风险更高[校正 HR，1.42；95%CI，1.13-1.79，P=0.003]、死亡率更高[校正比值比（OR）4.25；95%CI：2.99-6.04，P<0.001]和不良功能结局风险更高（校正 OR，4.25；95%CI：3.40-5.33，P<0.001），年龄组间趋势 P<0.001。