School of Computing Science, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
School of Computing Science, University of East Anglia, Norwich Research Park, Norwich, United Kingdom.
J Stroke Cerebrovasc Dis. 2022 Sep;31(9):106663. doi: 10.1016/j.jstrokecerebrovasdis.2022.106663. Epub 2022 Jul 27.
Transient ischaemic attacks (TIA) serve as warning signs for future stroke, and the impact of TIA on long term survival is uncertain. We assessed the long-term hazards of all-cause mortality following a first episode of a transient ischaemic attack (TIA).
Retrospective matched cohort study.
Cohort study using electronic primary health care records from The Health Improvement Network (THIN) database in the United Kingdom. Cases born in or before 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Double-Cox Weibull survival model with a random frailty effect of general practice, while adjusting for different socio-demographic factors, medical therapies, and comorbidities.
20,633 cases and 58,634 controls were included. During the study period, 24,176 participants died comprising of 7,745 (37.5%) cases and 16,431(28.0%) controls. In terms of hazards of mortality, cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to their 39-60 years matched controls (HR = 3.04 (2.91 - 3.18)). The HR for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to their same-aged matched controls. Cases aged 39-60 at TIA onset who were prescribed aspirin were associated with reduced HR of 0.93 (0.84 - 1.01), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5, 10 and 15 years respectively, compared to the same aged cases who were not prescribed any antiplatelet. Statistically significant reductions in hazard ratios were observed with aspirin at 10 and 15 years in all age groups. Hazard ratio point estimates for other antiplatelets (dipyridamole or clopidogrel) and dual antiplatelet therapy were very similar to aspirin at 5, 10 and 15 years but with wider confidence intervals that included 1. There was no survival benefit associated with antiplatelet prescription in controls.
The overall risk of death was considerably elevated in all age groups after a first-ever TIA event. Aspirin prescription was associated with a reduced risk. These findings support the use of aspirin in secondary prevention for people with a TIA. The results do not support the use of antiplatelet medication in people without TIA.
短暂性脑缺血发作（TIA）是未来中风的警告信号，但其对长期生存的影响尚不确定。我们评估了首次短暂性脑缺血发作（TIA）后全因死亡率的长期危害。
回顾性匹配队列研究。
使用英国健康改善网络（THIN）数据库中的电子初级保健记录进行队列研究。1986 年 1 月至 2017 年 1 月期间，出生于或之前在 1960 年，居住在英格兰，首次诊断为 TIA 的病例与年龄、性别和一般实践相匹配的 3 名对照者相匹配。主要结局为全因死亡率。使用时变双 Cox 威布尔生存模型，通过一般实践的随机脆弱性效应，估计全因死亡率的危害，同时调整不同的社会人口因素、医疗治疗和合并症。
共纳入 20633 例病例和 58634 例对照。在研究期间，有 24176 名参与者死亡，其中包括 7745 例（37.5%）病例和 16431 例（28.0%）对照。就死亡率的危害而言，首次 TIA 事件时年龄在 39 至 60 岁的病例与年龄相匹配的 39 至 60 岁对照者相比，死亡率的危害比最高（HR 为 3.04（2.91-3.18））。年龄在 61-70 岁、71-76 岁和 77 岁以上的病例的 HR 分别为 1.98（1.55-2.30）、1.79（1.20-2.07）和 1.52（1.15-1.97）与同年龄的匹配对照者相比。TIA 发病时年龄在 39-60 岁且服用阿司匹林的病例，与同年龄未服用任何抗血小板药物的病例相比，在 5 年、10 年和 15 年时的 HR 分别为 0.93（0.84-1.01）、0.90（0.82-0.98）和 0.88（0.80-0.96）。在所有年龄组中，在 10 年和 15 年时，服用阿司匹林可显著降低危险比。在 5 年、10 年和 15 年时，其他抗血小板药物（双嘧达莫或氯吡格雷）和双联抗血小板治疗的危险比点估计值与阿司匹林非常相似，但置信区间较宽，包括 1。在对照组中，抗血小板药物治疗与生存获益无关。
首次 TIA 后，所有年龄组的死亡总体风险显著升高。阿司匹林的处方与降低风险相关。这些发现支持在 TIA 后使用阿司匹林进行二级预防。结果不支持在没有 TIA 的情况下使用抗血小板药物。
