背景:观察到Org10172在急性卒中治疗(TOAST)亚型中的短期缺血性卒中(IS)预后差异。值得注意的是,对中国不同亚型的长期预后知之甚少。我们旨在调查IS患者的长期结局,并尝试探索IS亚型与抗血栓治疗之间的潜在相互作用。
方法:这是一个卒中幸存者的前瞻性队列。在神经内科被诊断为首次IS的患者,华西医院,四川大学于2010年1月至2019年12月招募。他们被跟踪到2022年9月以评估复发,死亡率,功能恢复。多变量Fine-Gray模型评估卒中复发,而Cox回归估计风险比。使用广义线性混合效应模型分析修正的Rankin量表评分(mRS)。
结果:在基线时,950名参与者中有589名(62.00%)为男性。最长的随访时间是150个月,最短的是1.5个月,中位随访时间为81.0个月。与大动脉粥样硬化(LAA)相比,心血管栓塞(CE)的死亡率最高(HR=4.43,95CI1.61-12.23)。在接受抗凝治疗的幸存者中,CE显示死亡风险降低(HR=0.18,95%CI0.04-0.80)。在功能恢复中,小动脉闭塞(SAO)显示出更有利的预后结果(β=-2.08,P<0.01,OR=0.13,95CI0.03-0.47)。在服用抗血小板药物的幸存者中,与LAA相比,SAO的功能恢复速度较慢(β=1.39,P=0.05,OR=3.99,95CI1.01-15.74)。
结论:首次IS后的长期结局因TOAST亚型而异。抗凝治疗在CE患者中提供长期益处。然而,在SAO患者中长期服用抗血小板药物在改善功能恢复方面可能受到限制.医师应仔细考虑不同IS亚型的治疗方案,以优化患者预后和中风护理效果。
BACKGROUND: Disparities in short-term ischemic stroke (IS) prognosis among Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes were observed. Notably, little is known about the long-term prognosis of different subtypes in
China. We aim to investigate the long-term outcome in IS patients and try to explore the potential interactive effects between IS subtypes and antithrombotic therapy.
METHODS: This is a prospective cohort of stroke survivors. Patients diagnosed with first-ever IS at the Department of Neurology, West
China Hospital, Sichuan University from January 2010 to December 2019 were recruited. They were followed until September 2022 to assess recurrence, mortality, and functional recovery. The multivariate Fine-Gray model assessed stroke recurrence, while Cox regression estimated hazard ratios. Modified Rankin Scale scores(mRS) were analyzed using the generalized linear mixed effects model.
RESULTS: At baseline, 589 of 950 participants (62.00 %) were male. The longest follow-up was 150 months, the shortest was 1.5 months, and the median follow-up was 81.0 months. Cardio-embolism (CE) bore the highest mortality risk compared to large artery atherosclerosis (LAA) (HR=4.43,95 %CI 1.61-12.23). Among survivors on anticoagulant therapy, CE exhibited a reduced risk of mortality (HR = 0.18, 95 % CI 0.04-0.80). In function recovery, small artery occlusion (SAO) demonstrated more favorable prognostic outcomes (β=-2.08, P<0.01, OR=0.13,95 %CI 0.03-0.47). Among survivors taking antiplatelet drugs, SAO demonstrated a slower pace of functional recovery compared to LAA (β=1.39, P=0.05, OR=3.99,95 %CI 1.01-15.74).
CONCLUSIONS: Long-term outcomes post-first IS vary among TOAST subtypes. Anticoagulant therapy offers long-term benefits among patients of the CE. However, prolonged administration of antiplatelet drugs among SAO patients may be limited in improving function recovery. Physicians should carefully consider treatment options for different IS subtypes to optimize patient outcomes and stroke care effectiveness.