Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.
Sci Rep. 2023 May 23;13(1):8333. doi: 10.1038/s41598-023-35601-x.
Data are scarce on long-term outcomes after ischemic stroke (IS) or transient ischemic attack (TIA). In this prospective cohort study, we examined the cumulative incidence of major adverse cardiovascular events (MACE) after IS and TIA using a competing risk model and factors associated with new events using a Cox-proportional hazard regression model. All patients discharged alive from Östersund Hospital with IS or TIA between 2010 and 2013 (n = 1535) were followed until 31 December 2017. The primary endpoint was a composite of IS, type 1 acute myocardial infarction (AMI), and cardiovascular (CV) death. Secondary endpoints were the individual components of the primary endpoint, in all patients and separated in IS and TIA subgroups. The cumulative incidence of MACE (median follow-up: 4.4 years) was 12.8% (95% CI: 11.2-14.6) within 1 year after discharge and 35.6% (95% CI: 31.8-39.4) by the end of follow-up. The risk of MACE and CV death was significantly increased in IS compared to TIA (p-values < 0.05), but not the risk of IS or type 1 AMI. Age, kidney failure, prior IS, prior AMI, congestive heart failure, atrial fibrillation, and impaired functional status, were associated with an increased risk of MACE. The risk of recurring events after IS and TIA is high. IS patients have a higher risk of MACE and CV death than TIA patients.
关于缺血性脑卒中（IS）或短暂性脑缺血发作（TIA）后长期结局的数据较为匮乏。在这项前瞻性队列研究中，我们使用竞争风险模型来评估 IS 和 TIA 后主要不良心血管事件（MACE）的累积发生率，并使用 Cox 比例风险回归模型来分析与新发事件相关的因素。所有于 2010 至 2013 年期间在厄斯特松德医院存活出院的 IS 或 TIA 患者（n=1535）均随访至 2017 年 12 月 31 日。主要终点是 IS、1 型急性心肌梗死（AMI）和心血管（CV）死亡的复合终点。次要终点是所有患者及 IS 和 TIA 亚组中主要终点的各个组成部分。MACE（中位随访时间：4.4 年）的累积发生率在出院后 1 年内为 12.8%（95%CI：11.2-14.6），在随访结束时为 35.6%（95%CI：31.8-39.4）。IS 患者发生 MACE 和 CV 死亡的风险明显高于 TIA 患者（p 值均<0.05），但 IS 或 1 型 AMI 的风险则不然。年龄、肾衰竭、既往 IS、既往 AMI、充血性心力衰竭、心房颤动和功能状态受损与 MACE 风险增加相关。IS 和 TIA 后复发事件的风险较高。IS 患者的 MACE 和 CV 死亡风险高于 TIA 患者。
