Barone Valentina, Foschi Matteo, Pavolucci Lucia, Rondelli Francesca, Rinaldi Rita, Nicodemo Marianna, D'Angelo Roberto, Favaretto Elisabetta, Brusi Carlotta, Cosmi Benilde, Degli Esposti Daniela, D'Addato Sergio, Bacchelli Stefano, Giostra Fabrizio, Pomata Daniela Paola, Spinardi Luca, Faccioli Luca, Faggioli Gianluca, Donti Andrea, Borghi Claudio, Cortelli Pietro, Guarino Maria
IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
Front Neurol. 2024 May 27;15:1407598. doi: 10.3389/fneur.2024.1407598. eCollection 2024.
Fast-track care have been proved to reduce the short-term risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short- and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management.
Prospective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017. All patients underwent fast-track care within 24 h of admission. The primary outcome was defined as the first stroke recurrence at 90 days, 12 and 60 months after TIA. Stroke incidence with 95% confidence interval (CI) at each timepoint was calculated using Poisson regression. Predictors of stroke recurrence were evaluated with Cox regression analysis. The number needed to treat (NNT) of fast-track care in preventing 90-day stroke recurrence in respect to the estimates based on baseline ABCD score was also calculated.
We enrolled 1,035 patients (54.2% males). Stroke incidence was low throughout the follow-up with rates of 2.2% [95% CI 1.4-3.3%] at 90 days, 2.9% [95% CI 1.9-4.2%] at 12 months and 7.1% [95% CI 5.4-9.0%] at 60 months. Multiple TIA, speech disturbances and presence of ischemic lesion at neuroimaging predicted stroke recurrence at each timepoint. Male sex and increasing age predicted 90-day and 60-month stroke risk, respectively. Hypertension was associated with higher 12-month and 60-month stroke risk. No specific TIA etiology predicted higher stroke risk throughout the follow-up. The NNT for fast-track care in preventing 90-day stroke was 14.5 [95% CI 11.3-20.4] in the overall cohort and 6.8 [95% CI 4.6-13.5] in patients with baseline ABCD of 6 to 7.
Our findings support the effectiveness of fast-track care in preventing both short- and long-term stroke recurrence after TIA. Particular effort should be made to identify and monitor patients with baseline predictors of higher stroke risk, which may vary according to follow-up duration.
快速通道护理已被证明可降低短暂性脑缺血发作（TIA）后短期中风风险。我们旨在调查一大群接受快速通道管理的TIA患者的中风风险，并确定短期和长期中风的预测因素。
前瞻性研究，纳入2010年8月至2017年12月期间入住意大利北部急诊科的连续TIA患者。所有患者在入院后24小时内接受快速通道护理。主要结局定义为TIA后90天、12个月和60个月时首次中风复发。使用泊松回归计算每个时间点95%置信区间（CI）的中风发病率。通过Cox回归分析评估中风复发的预测因素。还计算了快速通道护理相对于基于基线ABCD评分的估计值预防90天中风复发的治疗所需人数（NNT）。
我们纳入了1035例患者（54.2%为男性）。在整个随访期间中风发病率较低，90天时为2.2%[95%CI 1.4 - 3.3%]，12个月时为2.9%[95%CI 1.9 - 4.2%]，60个月时为7.1%[95%CI 5.4 - 9.0%]。多次TIA、言语障碍和神经影像学检查显示存在缺血性病变在每个时间点均预测中风复发。男性和年龄增长分别预测90天和60个月时的中风风险。高血压与12个月和60个月时较高的中风风险相关。在整个随访期间，没有特定的TIA病因预测较高的中风风险。在整个队列中，快速通道护理预防90天中风的NNT为14.5[95%CI 11.3 - 20.4]，在基线ABCD评分为6至7的患者中为6.8[95%CI 4.6 - 13.5]。
我们的研究结果支持快速通道护理在预防TIA后短期和长期中风复发方面的有效性。应特别努力识别和监测具有较高中风风险基线预测因素的患者，这些因素可能因随访时间而异。
