Pop G A, Koudstaal P J, Meeder H J, Algra A, van Latum J C, van Gijn J
Department of Cardiology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
Arch Neurol. 1994 Apr;51(4):333-41. doi: 10.1001/archneur.1994.00540160027005.
Patients with cerebral ischemia have a high mortality rate. The most common cause of death is myocardial infarction. We attempted to identify risk factors for subsequent cardiac events in patients with cerebral ischemia by means of the history and electrocardiography performed with the patient at rest.
The original inception cohort was entered in a multicenter randomized clinical trial (30 or 283 mg/d of aspirin) and followed up prospectively for a mean period of 2.6 years.
Patients were admitted to the hospital or seen in outpatient clinics.
Patients with one or more transient ischemic attacks (symptoms completely reversible within 24 hours) and patients with minor ischemic stroke (symptoms persisting for longer than 24 hours) were randomized, provided they were independent in most activities of daily living. Patients with a definite or probable source of embolism in the heart were excluded. A total of 3021 patients were included in the study. Follow-up was performed at 4-month intervals.
Primary cardiac outcome events were defined as nonfatal myocardial infarction and cardiac death. Cardiac death included sudden death, fatal myocardial infarction, or death due to congestive heart failure; 189 patients suffered a cardiac death--82 of which were sudden deaths--or nonfatal myocardial infarction.
By means of multivariate analysis, the following independent predictors for cardiac events were identified (hazards ratio/95% confidence limits): age older than 65 years (1.6/1.2 to 2.2), male sex (1.5/1.1 to 2.1), angina pectoris (1.5/1.0 to 2.3), diabetes (1.6/1.1 to 2.5), anterior infarction noted on electrocardiography (1.7/1.1 to 2.7), inverted T wave noted on the electrocardiogram (1.6/1.1 to 2.4), and left ventricular hypertrophy noted on electrocardiography (3.2/2.0 to 4.9).
The history and the electrocardiogram obtained with the patient at rest are valuable tools for cardiac risk assessment in patients with recent cerebral ischemia.
脑缺血患者死亡率很高。最常见的死亡原因是心肌梗死。我们试图通过病史及患者静息时的心电图检查来确定脑缺血患者发生后续心脏事件的危险因素。
最初的入组队列进入一项多中心随机临床试验（阿司匹林剂量为30或283毫克/天），并进行了平均2.6年的前瞻性随访。
患者入院或在门诊就诊。
有一次或多次短暂性脑缺血发作（症状在24小时内完全可逆）的患者以及轻度缺血性卒中（症状持续超过24小时）的患者被随机分组，前提是他们在大多数日常生活活动中能够自理。排除心脏有明确或可能的栓塞源的患者。共有3021名患者纳入研究。随访每4个月进行一次。
主要心脏结局事件定义为非致命性心肌梗死和心源性死亡。心源性死亡包括猝死、致命性心肌梗死或因充血性心力衰竭导致的死亡；189名患者发生了心源性死亡（其中82例为猝死）或非致命性心肌梗死。
通过多变量分析，确定了以下心脏事件的独立预测因素（风险比/95%置信区间）：年龄大于65岁（1.6/1.2至2.2）、男性（1.5/1.1至2.1）、心绞痛（1.5/1.0至2.3）、糖尿病（1.6/1.1至2.5）、心电图显示前壁梗死（1.7/1.1至2.7）、心电图显示T波倒置（1.6/1.1至2.4）以及心电图显示左心室肥厚（3.2/2.0至4.9）。
患者静息时的病史和心电图是近期脑缺血患者心脏风险评估的重要工具。
