Karvelas Nikolaos, Palaiodimos Leonidas, Karamanis Dimitrios, Sagris Dimitrios, Louka Anna-Maria, Papanagiotou Panagiotis, Korompoki Eleni, Ntaios George, Vemmos Konstantinos
Departments of Neurology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
Eur Stroke J. 2024 Dec 3:23969873241302657. doi: 10.1177/23969873241302657.
There is paucity of data on the long-term outcomes after acute ischemic posterior circulation stroke (PCS). Additionally, the long-term prognostic value of the New England Medical Center-Posterior Circulation Registry (NEMC-PCR) classification of PCS has not been studied.
All consecutive patients with PCS registered in the Athens Stroke Registry between 01/1993 and 12/2012 were prospectively followed for up to 10 years and included in the analysis. The NEMC-PCR criteria were applied to classify them in relation to topography. The main studied outcomes were all cause mortality, stroke recurrence and major adverse cardiovascular events (MACEs).
A total of 653 patients with PCS (455 men, mean age 68.06 years) were followed up for 52.8 ± 44.0 months. Seventy-four (11.3%), 219 (33.5%), 335 (51.3%), and 25 (3.8%) patients had proximal, middle, distal, and multiple territories PCS, respectively. During the 10-year follow-up period, 217 patients died (7.6 per 100 patient years), 127 developed recurrent stroke (4.2 per 100 patient years), and 209 had a MACE (7.3 per 100 patient years). The cumulative 10-year mortality was higher in distal and multiple territories PCS compared to middle and proximal PCS (55.6%, 58.8%, 40.0%, 35.5%, respectively, < 0.001 by log-rank test). Patients with distal location PCS had almost twofold increased 10-year risk of mortality compared to proximal location patients after adjusting for all confounding variables (HR 1.99, 95% CI 1.05-3.77). Per TOAST classification, large artery atherosclerosis was associated with almost two-fold increase in risk of mortality, stroke recurrence and MACEs.
A large proportion of PCS patients experienced 10-year death, stroke and MACE occurrence after PCS. NEMC-PCR topographic classification was found to have significant prognostic value, with distal and middle PCS having worse long-term outcomes than proximal PCS.
关于急性缺血性后循环卒中（PCS）的长期预后数据较少。此外，新英格兰医学中心后循环登记处（NEMC-PCR）对PCS的分类的长期预后价值尚未得到研究。
对1993年1月至2012年12月期间在雅典卒中登记处登记的所有连续性PCS患者进行了前瞻性随访，最长随访10年，并纳入分析。应用NEMC-PCR标准根据病变部位对患者进行分类。主要研究结局为全因死亡率、卒中复发和主要不良心血管事件（MACE）。
共纳入653例PCS患者（455例男性，平均年龄68.06岁），随访时间为52.8±44.0个月。分别有74例（11.3%）、219例（33.5%）、335例（51.3%）和25例（3.8%）患者的病变位于近端、中段、远端和多个部位。在10年随访期内，217例患者死亡（每100患者年7.6例），127例发生复发性卒中（每100患者年4.2例），209例发生MACE（每100患者年7.3例）。与中段和近端PCS相比，远端和多部位PCS的累积10年死亡率更高（分别为55.6%、58.8%、40.0%、35.5%，对数秩检验P<0.001）。在调整所有混杂变量后，远端病变的PCS患者10年死亡风险比近端患者增加近两倍（HR 1.99，95%CI 1.05-3.77）。根据TOAST分类，大动脉粥样硬化与死亡、卒中复发和MACE风险增加近两倍相关。
很大一部分PCS患者在发病后10年出现死亡、卒中和MACE。结果发现，NEMC-PCR部位分类具有重要的预后价值，远端和中段PCS的长期预后比近端PCS更差。
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