Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China.
Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University 610041, PR China; Public Health Center, Tianfu New Area Disease Prevention and Control Center, Sichuan, PR China.
J Stroke Cerebrovasc Dis. 2024 Aug;33(8):107783. doi: 10.1016/j.jstrokecerebrovasdis.2024.107783. Epub 2024 Jun 18.
Disparities in short-term ischemic stroke (IS) prognosis among Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes were observed. Notably, little is known about the long-term prognosis of different subtypes in China. We aim to investigate the long-term outcome in IS patients and try to explore the potential interactive effects between IS subtypes and antithrombotic therapy.
This is a prospective cohort of stroke survivors. Patients diagnosed with first-ever IS at the Department of Neurology, West China Hospital, Sichuan University from January 2010 to December 2019 were recruited. They were followed until September 2022 to assess recurrence, mortality, and functional recovery. The multivariate Fine-Gray model assessed stroke recurrence, while Cox regression estimated hazard ratios. Modified Rankin Scale scores(mRS) were analyzed using the generalized linear mixed effects model.
At baseline, 589 of 950 participants (62.00 %) were male. The longest follow-up was 150 months, the shortest was 1.5 months, and the median follow-up was 81.0 months. Cardio-embolism (CE) bore the highest mortality risk compared to large artery atherosclerosis (LAA) (HR=4.43,95 %CI 1.61-12.23). Among survivors on anticoagulant therapy, CE exhibited a reduced risk of mortality (HR = 0.18, 95 % CI 0.04-0.80). In function recovery, small artery occlusion (SAO) demonstrated more favorable prognostic outcomes (β=-2.08, P<0.01, OR=0.13,95 %CI 0.03-0.47). Among survivors taking antiplatelet drugs, SAO demonstrated a slower pace of functional recovery compared to LAA (β=1.39, P=0.05, OR=3.99,95 %CI 1.01-15.74).
Long-term outcomes post-first IS vary among TOAST subtypes. Anticoagulant therapy offers long-term benefits among patients of the CE. However, prolonged administration of antiplatelet drugs among SAO patients may be limited in improving function recovery. Physicians should carefully consider treatment options for different IS subtypes to optimize patient outcomes and stroke care effectiveness.
在 Trial of Org 10172 in Acute Stroke Treatment（TOAST） 分型中观察到短期缺血性卒中（IS）预后存在差异。值得注意的是，关于中国不同亚型的长期预后知之甚少。我们旨在研究 IS 患者的长期结局，并尝试探讨 IS 亚型与抗血栓治疗之间的潜在交互作用。
这是一项前瞻性卒中幸存者队列研究。2010 年 1 月至 2019 年 12 月，在四川大学华西医院神经内科诊断为首次 IS 的患者被招募入组。随访至 2022 年 9 月，评估复发、死亡和功能恢复情况。多变量 Fine-Gray 模型评估卒中复发，Cox 回归估计风险比。采用广义线性混合效应模型分析改良 Rankin 量表（mRS）评分。
基线时，950 名参与者中有 589 名（62.00%）为男性。最长随访时间为 150 个月，最短随访时间为 1.5 个月，中位随访时间为 81.0 个月。与大动脉粥样硬化（LAA）相比，心源性栓塞（CE）具有更高的死亡风险（HR=4.43，95%CI 1.61-12.23）。在接受抗凝治疗的幸存者中，CE 的死亡风险降低（HR=0.18，95%CI 0.04-0.80）。在功能恢复方面，小动脉闭塞（SAO）表现出更有利的预后结局（β=-2.08，P<0.01，OR=0.13，95%CI 0.03-0.47）。在接受抗血小板药物治疗的幸存者中，与 LAA 相比，SAO 表现出较慢的功能恢复速度（β=1.39，P=0.05，OR=3.99，95%CI 1.01-15.74）。
首次 IS 后长期结局在 TOAST 亚型中存在差异。抗凝治疗在 CE 患者中具有长期获益。然而，在 SAO 患者中延长抗血小板药物的使用可能会限制功能恢复的改善。医生应仔细考虑不同 IS 亚型的治疗选择，以优化患者结局和卒中治疗效果。
