Safi Habibullah, Kristensen Søren Lund, Sørensen Rikke, Kruuse Christina, Johnsen Søren Paaske, Gislason Gunnar, Torp-Pedersen Christian, Køber Lars, Fosbøl Emil L, Vinding Naja Emborg
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark (H.S., S.L.K., R.S., L.K., E.L.F., N.E.V.).
Department of Neurology, Copenhagen University Hospital, Herlev and Gentofte, Denmark (C.K.).
Stroke. 2025 Feb;56(2):478-487. doi: 10.1161/STROKEAHA.123.045605. Epub 2024 Dec 27.
Sparse information regarding the long-term risk of acute myocardial infarction (MI) following a transient ischemic attack (TIA) emphasizes further research to guide preventive strategies and risk stratification in patients with a TIA.
We conducted a nationwide cohort study to investigate the 5-year risk of MI and all-cause mortality in patients with a first-time TIA. Patients with a first-time TIA were identified in the Danish Stroke Registry (2013-2020), matched on age, sex, and calendar year (1:4) with the general population and (1:1) with patients with first-time ischemic stroke. The 5-year risks of MI and all-cause mortality were estimated by the Aalen-Johansen and Kaplan-Meier estimators. The groups were compared using Cox regression, while adjusting for cardiovascular comorbidities.
We identified 21 743 patients with TIA, 86 972 matched individuals from the general population, and 21 743 matched control patients with ischemic stroke. Median age was 70 (25th to 75th percentile, 60-78) years; 52% were male. Comorbidity burden was the lowest in general population controls, intermediate in patients with TIA, and the highest in patients with ischemic stroke. The 5-year risk of MI was 2.0% in patients with TIA, 1.5% in the general population (<0.001), and 2.2% in the ischemic stroke population (<0.001). After adjustment, these differences in MI rate were similar (TIA versus general population; hazard ratio, 0.99 [95% CI, 0.98-1.02] and TIA versus ischemic stroke; hazard ratio, 0.99 [95% CI, 0.96-1.01]). The 5-year risk of mortality was 17.0% in patients with TIA compared with 14.0% in the general population (<0.001) and 27.0% in ischemic stroke population (<0.001). The differences in mortality persisted following adjustments for patients with TIA versus general population (hazard ratio, 1.25 [95% CI, 1.19-1.31]) and for patients with TIA versus ischemic stroke (hazard ratio, 0.43 [95% CI, 0.41-0.46]).
Patients with first-time TIA had a low 5-year incidence of MI, which was not significantly different from that of the general population and patients with first-time ischemic stroke after adjustments for comorbidities. However, patients with TIA had a 25% higher all-cause mortality rate than the general population, which was not readily explained by MI risk. Hence, the findings do not endorse the need to raise further awareness regarding MI in patients with TIA.
关于短暂性脑缺血发作（TIA）后急性心肌梗死（MI）长期风险的信息匮乏，这凸显了进一步开展研究以指导TIA患者预防策略和风险分层的必要性。
我们开展了一项全国性队列研究，以调查首次发生TIA患者的5年MI风险和全因死亡率。在丹麦卒中登记处（2013 - 2020年）中识别出首次发生TIA的患者，按照年龄、性别和日历年进行匹配（1:4）与一般人群，以及（1:1）与首次发生缺血性卒中的患者。采用Aalen-Johansen法和Kaplan-Meier法估计5年MI风险和全因死亡率。使用Cox回归对各组进行比较，同时调整心血管合并症。
我们识别出21743例TIA患者、86972例来自一般人群的匹配个体以及21743例匹配的缺血性卒中对照患者。中位年龄为70岁（第25至75百分位数，60 - 78岁）；52%为男性。合并症负担在一般人群对照组中最低，在TIA患者中居中，在缺血性卒中患者中最高。TIA患者的5年MI风险为2.0%，一般人群为1.5%（<0.001），缺血性卒中人群为2.2%（<0.001）。调整后，MI发生率的这些差异相似（TIA与一般人群相比；风险比，0.99 [95%CI，0.98 - 1.02]；TIA与缺血性卒中相比；风险比，0.99 [95%CI，0.96 - 1.01]）。TIA患者的5年死亡率为17.0%，而一般人群为14.0%（<0.001），缺血性卒中人群为27.0%（<0.001）。在对TIA患者与一般人群进行调整后（风险比，1.25 [95%CI，1.19 - 1.31]）以及TIA患者与缺血性卒中患者进行调整后（风险比，0.43 [95%CI，0.41 - 0.46]），死亡率差异仍然存在。
首次发生TIA的患者5年MI发病率较低，在调整合并症后与一般人群和首次发生缺血性卒中的患者无显著差异。然而，TIA患者的全因死亡率比一般人群高25%，这不能简单地用MI风险来解释。因此，这些发现并不支持有必要进一步提高对TIA患者MI的认识。
