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
Trends and predictors of myocardial infarction or vascular death after ischaemic stroke or TIA in China, 2007-2018: insights from China National Stroke Registries
第一作者：Li Long
2020-10-30
已发表文章
发表杂志：Stroke and Vascular Neurology
发表类型: Original Research
影响因子(IF): 4.081
PMID: 33127855 Pubmed原文链接 全文下载
主要研究背景及目的
急性缺血性脑卒中（Acute ischemic stroke，AIS）和短暂性脑缺血发作（Transient ischemic attack，TIA）患者发生心肌梗死（acute myocardial infarction，AMI）的风险仍存在一定的争议。2018发表的JAHA的一篇Meta分析指出，当前指南并未将缺血性卒中患者纳入十年心血管事件预防的高危人群，而部分学者提出应当纳入较为严重的AIS患者。因为既往的研究通常随访时间较短，缺乏长程研究；此外，不同AIS病因心梗风险的研究较少；同时，也缺乏卒中后心梗的预测因素的可靠研究[1]。 2017年发表在Stroke的一项全美的卒中研究发现：一方面，与卒中复发相比，AIS和TIA患者住院心梗的发病率相对较低，卒中患者住院心梗发生率为1.6%，但发病率是逐年增加的；另一方面，卒中后心梗的住院死亡率，住院时长和花费分别是非心梗的3倍，1.5倍，1.5倍。提示：卒中后心梗对短期生存和资源利用造成较大负面影响[2]。而我国缺乏相关的国家注册研究，既往的相关研究样本量小、事件数少，不具有代表性。如一个研究仅招募北京5家社区医院710名首次发生缺血性卒中患者，且发生的事件少-包括全因死亡，心血管事件和再发卒中在内的总计117个事件[3]。 因此，本研究旨在一个全国范围性的数据库中，探讨中国AIS和TIA患者发生心梗风险的现状和与之相关的危险因素。
方法
Data were obtained from the three phases of China National Stroke Registry (CNSR), including CNSR-Ⅰ (years 2007-2008), CNSR-Ⅱ (years 2012-2013) and CNSR-III (years 2015-2018). For comparison, patients who were diagnosed as ischaemic stroke or TIA were included. Kaplan-Meier estimates of myocardial infarction (MI) or vascular death were calculated at 1 year. Independent predictors were further assessed with a Cox proportional hazards regression.
结论
A declining trend and current low incidence of MI or vascular death, rather than recurrent stroke, after ischaemic stroke or TIA were observed in China. Traditional factors were found as independent predictors. These findings suggested there is still much room to improve for stroke management.
主要结果
From 2007 to 2018, a total of 50 284 patients with ischaemic stroke or TIA were enrolled in this study. A declining trend was found in 1-year MI or vascular death (p for trend <0.001), while recurrent stroke depicted a U-shape curve with a nadir in 2012-2013 cohort. A similar trend was also observed in patients who were admitted to 26 hospitals in all three CNSRs. In 2015-2018 cohort, only 251 (1.7%; 95% CI 1.5% to 1.9%) MI or vascular death had occurred at 1 year. Older age, previous stroke or TIA, history of coronary artery disease and the National Institutes of Health Stroke Scale >6 were associated with both an increased risk of MI or vascular death and recurrent stroke. While early antiplatelet therapy and lipid-lowering agents at discharge predicted a reduced risk.