国家神经系统疾病临床医学研究中心数据管理与共享系统

Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

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Nontraditional Risk Factors for Residual Recurrence Risk in Patients with Ischemic Stroke of Different Etiologies

第一作者：Xu Jie，Mo Jinglin

通讯作者：Wang Yongjun

Nontraditional risk factor · Ischemic stroke · Large-artery atherosclerosis · Small-artery occlusion

基本信息

2022-04-07

已发表文章

发表杂志：Cerebrovascular Diseases

发表类型: Original Contributions

影响因子(IF): 3.104

PMID: 35390802 Pubmed原文链接 全文下载

主要研究背景及目的

Findings from The United States Preventive Services Task Force study suggested that several nontraditional factors can partly explain the residual risk of cardiovascular disease. However, ischemic stroke is a complication caused by a group of etiologies not only atherosclerosis. Whether the current guideline recommended secondary prevention is effective and the contribution of non-traditional risk factors to residual risk were different among patients with ischemic stroke of different etiologies is unclear. Therefore, our study aims to evaluate the residual risk of stroke recurrence and to identify the determinants of residual risk in patients with various etiologies under persistent standard secondary prevention.

方法

We used 5 evidence-based interventions (antiplatelet therapy, warfarin for atrial fibrillation, antihypertensive therapy, antidiabetic therapy and statins) to document the performance of secondary prevention care of ischemic cerebrovascular event for each patient. The etiology subtypes of ischemic stroke were classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. The association between different nontraditional risk factors and stroke outcomes was analyzed using cox regression models. The incremental predictive value of nontraditional risk factors was analyzed by the Harrell c index.

结论

LAA and SAO subtypes own the specific nontraditional risk factors while inflammation is a common risk factor for residual recurrence risk of both.

主要结果

In total, 9,733 patients were included in this study. At 3 months, 4,186 (43.0%) patients adhered to 5 secondary prevention strategies, and the residual risk of recurrence was 5.1%. According to Trial of Org 10172 in Acute Stroke Treatment subtypes, cardioembolism benefited the most from current secondary prevention (relative risk reduction: 65.2%), followed by large-artery atherosclerosis (LAA) (29.0%) and small-artery occlusion (SAO) (20.0%). Despite adhering to secondary prevention strategies, high sensitivity C-reactive protein, interleukin-6 (IL-6) levels, and impaired renal function were independent risk factors for the residual recurrence risk of LAA subtype,while IL-6 and trimethylamine N-oxide significantly contributed to the residual risk of SAO subtype.