Liu Pen-Ju, Liu Shui-Ping, Yuan Peng
Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Tex Heart Inst J. 2024 Dec 20;51(2):e248428. doi: 10.14503/THIJ-24-8428. eCollection 2024 Jul-Dec.
Cardiogenic stroke is associated with substantial morbidity and mortality, necessitating a better understanding of its clinical characteristics for improved patient outcomes. This study aimed to identify clinical characteristics influencing short-term functional prognosis in patients with cardiogenic stroke.
The study prospectively enrolled 212 patients with cardiogenic stroke, collecting their clinical data and laboratory results. The modified Rankin Scale score at 90 days was used to define functional prognosis, with patients having a good prognosis (modified Rankin Scale ≤2; n = 164) or poor prognosis (modified Rankin Scale ≥3; n = 48).
The poor prognosis group had higher rates of total anterior circulation infarcts (12.5% vs 0.0%; < .001) and posterior circulation infarction (50.0% vs 38.4%; < .001) compared with the good prognosis group. Lesion characteristics differed significantly, with the poor prognosis group exhibiting more large-area lesions (39.6% vs 18.9%; < .001) and multiple confluent lesions (56.3% vs 24.4%; < .001). Admission-based National Institute of Health Stroke Scale scores were higher in the poor prognosis group (median [IQR], 12 [8-18] vs 5 [4-7]; <.001), correlating with worse outcomes. The admission National Institute of Health Stroke Scale score predicted patients' 90-day prognosis with good accuracy (area under the curve, 0.937 [95% CI, 0.895-0.965]; < .001), with a threshold of 7 yielding 85.42% sensitivity and 85.37% specificity.
Higher admission National Institute of Health Stroke Scale scores were significantly associated with poor functional prognosis at 90 days, highlighting the importance of early National Institute of Health Stroke Scale-based assessment for improved outcomes.
心源性卒中与较高的发病率和死亡率相关,因此有必要更好地了解其临床特征以改善患者预后。本研究旨在确定影响心源性卒中患者短期功能预后的临床特征。
本研究前瞻性纳入了212例心源性卒中患者,收集他们的临床资料和实验室检查结果。采用90天时的改良Rankin量表评分来定义功能预后,预后良好(改良Rankin量表评分≤2;n = 164)或预后不良(改良Rankin量表评分≥3;n = 48)。
与预后良好组相比,预后不良组的完全前循环梗死发生率更高(12.5% 对0.0%;P <.001),后循环梗死发生率也更高(50.0% 对38.4%;P <.001)。病变特征存在显著差异,预后不良组出现更多大面积病变(39.6% 对18.9%;P <.001)和多个融合性病变(56.3% 对24.4%;P <.001)。预后不良组基于入院时的美国国立卫生研究院卒中量表评分更高(中位数[四分位间距],12[8 - 18]对5[4 - 7];P <.001),这与更差的预后相关。入院时的美国国立卫生研究院卒中量表评分能较好地预测患者90天的预后(曲线下面积,0.937[95%置信区间,0.895 - 0.965];P <.001),阈值为7时,灵敏度为85.42%,特异度为85.37%。
较高的入院时美国国立卫生研究院卒中量表评分与90天时不良功能预后显著相关,突出了早期基于美国国立卫生研究院卒中量表的评估对改善预后的重要性。