心脑梗死发病率及结局的队列研究：基于两项全国人口登记的研究。
Incidence and Outcomes of Cardiocerebral Infarction: A Cohort Study of 2 National Population-Based Registries.
机构信息
Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.).
Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (H.Z.).
出版信息
Stroke. 2024 Sep;55(9):2221-2230. doi: 10.1161/STROKEAHA.123.044530. Epub 2024 Jul 31.
BACKGROUND
Cardiocerebral infarction (CCI), which is concomitant with acute myocardial infarction (AMI) and acute ischemic stroke (AIS), is a rare but severe presentation. However, there are few data on CCI, and the treatment options are uncertain. We investigated the characteristics and outcomes of CCI compared with AMI or AIS alone.
METHODS
We performed a retrospective cohort study of 120 531 patients with AMI and AIS from the national stroke and AMI registries in Singapore. Patients were categorized into AMI only, AIS only, synchronous CCI (same-day), and metachronous CCI (within 1 week). The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. The mortality risks were compared using Cox regression. Multivariable models were adjusted for baseline demographics, clinical variables, and treatment for AMI or AIS.
RESULTS
Of 127 919 patients identified, 120 531 (94.2%) were included; 74 219 (61.6%) patients had AMI only, 44 721 (37.1%) had AIS only, 625 (0.5%) had synchronous CCI, and 966 (0.8%) had metachronous CCI. The mean age was 67.7 (SD, 14.0) years. Synchronous and metachronous CCI had a higher risk of 30-day mortality (synchronous: adjusted HR [aHR], 2.41 [95% CI, 1.77-3.28]; metachronous: aHR, 2.80 [95% CI, 2.11-3.73]) than AMI only and AIS only (synchronous: aHR, 2.90 [95% CI, 1.87-4.51]; metachronous: aHR, 4.36 [95% CI, 3.03-6.27]). The risk of cardiovascular mortality was higher in synchronous and metachronous CCI than AMI (synchronous: aHR, 3.03 [95% CI, 2.15-4.28]; metachronous: aHR, 3.41 [95% CI, 2.50-4.65]) or AIS only (synchronous: aHR, 2.58 [95% CI, 1.52-4.36]; metachronous: aHR, 4.52 [95% CI, 2.95-6.92]). In synchronous CCI, AMI was less likely to be managed with PCI and secondary prevention medications (<0.001) compared with AMI only.
CONCLUSIONS
Synchronous CCI occurred in 1 in 200 cases of AIS and AMI. Synchronous and metachronous CCI had higher mortality than AMI or AIS alone.
背景
同时并发急性心肌梗死（AMI）和急性缺血性卒中（AIS）的脑心梗死（CCI）较为少见但却十分严重。然而，CCI 的相关数据很少，其治疗方案也不明确。我们旨在研究与 AMI 或 AIS 单独发病相比，CCI 的特征和结局。
方法
我们对来自新加坡国家卒中及 AMI 登记处的 120531 例 AMI 和 AIS 患者进行了回顾性队列研究。患者分为 AMI 组、AIS 组、同时性 CCI（同日）组和异时性 CCI（1 周内）组。主要结局为全因死亡率，次要结局为心血管死亡率。采用 Cox 回归比较死亡率风险。多变量模型调整了基线人口统计学、临床变量和 AMI 或 AIS 的治疗情况。
结果
在纳入的 127919 例患者中，120531 例（94.2%）符合入选标准；74219 例（61.6%）为 AMI 组，44721 例（37.1%）为 AIS 组，625 例（0.5%）为同时性 CCI 组，966 例（0.8%）为异时性 CCI 组。患者平均年龄为 67.7（标准差，14.0）岁。与 AMI 或 AIS 单独发病相比，同时性和异时性 CCI 发病 30 天内的死亡率更高（同时性：校正后 HR [aHR]，2.41[95%CI，1.77-3.28]；异时性：aHR，2.80[95%CI，2.11-3.73]）。与 AMI 或 AIS 单独发病相比，同时性和异时性 CCI 的心血管死亡率更高（同时性：aHR，3.03[95%CI，2.15-4.28]；异时性：aHR，3.41[95%CI，2.50-4.65]）。与 AMI 单独发病相比，同时性 CCI 患者接受经皮冠状动脉介入治疗和二级预防药物治疗的可能性更小（均<0.001）。
结论
同时性 CCI 占 AIS 和 AMI 患者的 1/200。同时性和异时性 CCI 的死亡率高于 AMI 或 AIS 单独发病。
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