欧洲三种不同社会经济环境下急性缺血性脑卒中的基线特征、再灌注治疗二级预防及预后。
Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe.
机构信息
Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Department of Neurology, Medical University of Gdansk, Gdansk, Poland.
出版信息
Eur Stroke J. 2024 Dec;9(4):1043-1052. doi: 10.1177/23969873241245518. Epub 2024 May 14.
INTRODUCTION
The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke.
PATIENTS AND METHODS
In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/ = 293 (high-income), Gdansk/PL/ = 140 (high-income), and Lutsk/UA/ = 188 (lower-middle-income).
RESULTS
We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) ( < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted- = 0.01/adjusted- CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted- < 0.001/adjusted- CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted- = 0.71/adjusted- CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted- < 0.001/adjusted- CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted- = 0.245/adjusted- CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up.
DISCUSSION AND CONCLUSION
Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.
简介
欧洲各国之间的血管危险因素和卒中负担存在显著差异，但对于社会经济环境对急性缺血性卒中后二级预防和结局的质量的影响，我们的了解有限。
患者和方法
在这项观察性多中心队列研究中，我们分析了来自三家三级教学医院的急性缺血性卒中患者的基线特征、再灌注治疗、结局和二级预防，这三家医院的服务人群规模相似，但社会经济环境不同：伯尔尼/瑞士（高收入）293 例，格但斯克/波兰（高收入）140 例，卢茨克/乌克兰（中下等收入）188 例。
结果
我们分析了 621 名患者（43.2%为女性，中位年龄 71.4 岁），于 2019 年 7 月至 12 月期间入院。我们观察到了显著的差异，包括中位 BMI（瑞士 26/波兰 27.7/乌克兰 27.8）、卒中严重程度[（中位 NIHSS 瑞士 4（0-40）/波兰 11（0-33）/乌克兰 7（1-30）]、初始神经影像学检查（CT：瑞士 21.6%/波兰 50.7%/乌克兰 71.3%）、保守治疗（瑞士 34.1%/波兰 38.6%/乌克兰 95.2%）（均 P<0.001），动脉高血压（瑞士 63.8%/波兰 72.6%/乌克兰 87.2%）、心房颤动（瑞士 28.3%/波兰 41.4%/乌克兰 39.4%）、高脂血症（瑞士 84.9%/波兰 76.4%/乌克兰 17%）（均 P<0.001）和主动吸烟（瑞士 32.2%/波兰 27.3%/乌克兰 10.2%）（P<0.007）。在瑞士、波兰和乌克兰，3 个月时的良好结局（mRS=0-2）分别为 63.1%、50%和 59%（未校正 P=0.01/校正后 P=0.601 和 P=0.981），3 个月时的优秀结局（mRS=0-1）分别为 48.5%、32.1%和 27%（未校正 P<0.001/校正后 P=0.201 和 P=0.08），校正后 OR 瑞士-乌克兰=0.201 和 0.08，校正后 OR 瑞士-乌克兰=2.09。各组之间 3 个月的死亡率相似（瑞士 17.2%、波兰 15.7%、乌克兰 4.8%）（未校正 P=0.71/校正后 P=0.08 和 P=0.24）。3 个月时复发卒中/TIA 分别为瑞士 3.1%、波兰 10.7%和乌克兰 3.1%，校正后 OR 瑞士-波兰=0.04 和 0.32。3 个月的随访药物治疗率在抗高血压药物方面相同。他汀类药物/口服抗凝剂的摄入量在乌克兰最低，分别为 67.1%和 25.5%（瑞士 87.3%和 39.2%，未校正 P<0.001/校正后 P=0.02 和 P=0.012，校正后 OR 瑞士-乌克兰=0.02 和 0.012，校正后 OR 瑞士-乌克兰=2.33 和 2.18）。口服降糖药的摄入量在瑞士最低，为 10.8%（波兰 15.7%和乌克兰 16.1%，未校正 P=0.245/校正后 P=0.061 和 P=0.002，校正后 OR 瑞士-乌克兰=0.25）。在随访期间，所有组的吸烟率均下降。
讨论和结论
瑞士和乌克兰之间调整后 3 个月优秀结局的差异高达两倍，这与临床表现、治疗和二级预防措施的显著差异相关。这突显了社会经济因素对卒中结局的重要性，强调了有必要针对治疗和二级预防策略中的差异进行有针对性的干预。
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