The College, The University of Chicago, Chicago, IL, USA.
Department of Neurology, MC2030, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
BMC Neurol. 2022 May 14;22(1):177. doi: 10.1186/s12883-022-02703-4.
Recent trials of acute secondary prevention in patients with minor ischemic stroke or transient ischemic attack (TIA) have demonstrated high rates of early recurrence within days of the initial event. Identifying clinical features associated with early recurrence may guide focused management.
Using logistic regression applied to the data of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, we evaluated what baseline clinical factors predict outcome events occurring within 7 days of randomization.
In the POINT trial, 181 subjects (3.7%) had early recurrence, defined as primary outcome events within 7 days of trial entry, whereas only 100 outcome events occurred over the remainder of the 90 day trial. Protective effects of dual antiplatelet therapy with clopidogrel plus aspirin were seen only as a reduction in these early recurrences, without any impact on later events. In univariate analysis, systolic blood pressure, diastolic blood pressure, serum glucose, initial carotid imaging results, study cohort (minor stroke or TIA), and treatment assignment were significantly associated with early recurrence. Multivariate logistic regression analysis identified a number of factors with significant independent associations with early recurrence, including carotid stenosis or occlusion (Odds Ratio [OR] 2.77; 95% confidence interval [CI] 1.78-4.31), cohort (minor stroke versus TIA) (OR 1.86; 95% CI 1.33-2.58), race (OR 1.57; 95% CI 1.10-2.25), baseline statin use (OR 0.68; 95% CI 0.49-0.95), systolic blood pressure (OR 1.10; 95% CI 1.03-1.18), serum glucose (OR 1.03; 95% CI 1.01-1.05), and age (OR 1.02; 95% CI 1.00-1.03). Receiver Operator Characteristic (ROC) analysis showed a 70% accuracy of the resulting logistic model in predicting early recurrence.
Early recurrence is high, and is concentrated in the first 7 days, in patients with minor stroke or TIA. A number of baseline clinical factors, including carotid disease, presentation with minor stroke rather than TIA, race, absence of statin usage, systolic blood pressure, and serum glucose, are independently associated with early event recurrence in the POINT trial population.
最近在轻度缺血性卒中和短暂性脑缺血发作（TIA）患者中进行的急性二级预防试验表明，在初始事件发生后的几天内，早期复发的发生率很高。识别与早期复发相关的临床特征可能有助于指导有针对性的治疗。
我们使用逻辑回归分析了 Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke（POINT）试验的数据，评估了哪些基线临床因素可以预测随机分组后 7 天内发生的结局事件。
在 POINT 试验中，181 名患者（3.7%）发生了早期复发，定义为试验入组后 7 天内发生的主要结局事件，而在 90 天试验的其余时间内仅发生了 100 例结局事件。氯吡格雷联合阿司匹林双联抗血小板治疗的保护作用仅表现为减少这些早期复发，对后期事件没有影响。单因素分析显示，收缩压、舒张压、血清葡萄糖、初始颈动脉影像学结果、研究队列（轻度卒中和 TIA）和治疗分配与早期复发显著相关。多因素逻辑回归分析确定了一些与早期复发有显著独立关联的因素，包括颈动脉狭窄或闭塞（比值比 [OR] 2.77；95%置信区间 [CI] 1.78-4.31）、队列（轻度卒中和 TIA）（OR 1.86；95% CI 1.33-2.58）、种族（OR 1.57；95% CI 1.10-2.25）、基线他汀类药物使用（OR 0.68；95% CI 0.49-0.95）、收缩压（OR 1.10；95% CI 1.03-1.18）、血清葡萄糖（OR 1.03；95% CI 1.01-1.05）和年龄（OR 1.02；95% CI 1.00-1.03）。受试者工作特征（ROC）分析显示，该逻辑模型在预测早期复发方面的准确率为 70%。
在轻度卒中和 TIA 患者中，早期复发率很高，且集中在最初的 7 天内。许多基线临床因素，包括颈动脉疾病、表现为轻度卒而非 TIA、种族、未使用他汀类药物、收缩压和血清葡萄糖，与 POINT 试验人群中的早期事件复发独立相关。
