■缺乏关于院内缺血性卒中的高质量国家级数据,阻碍了为该亚组的识别制定量身定制的策略,治疗,和管理。
■我们分析并比较了临床特征,院内管理措施,和结果,包括违反医疗建议的死亡或出院(DAMA),主要不良心血管事件(MACE),出院时的残疾,以及2015年8月至2022年12月在中国卒中中心协会注册中纳入的院内和社区发作性缺血性卒中的院内并发症.
■该队列包括14,948名住院患者和1,366,898名社区发作性缺血性中风患者。院内缺血性卒中表现出更大的卒中严重程度,合并症患病率较高,更多的入院前药物,管理措施欠佳,例如,4.5h内的起针时间(83.3%vs.93.1%;差异,-9.8%[-11.4%至-8.3%]),和出院时的抗血栓药(78.6%vs.90.0%;差异,-11.4%[95%CI,-12.1%至-10.7%])。在调整协变量后,院内缺血性卒中仍然与不良结局的高风险相关,包括住院死亡/DAMA(13.9%vs.8.6%;调整后的风险差异[aRD],2.2%[95%CI,1.8%-2.7%];调整后优势比[aOR],1.35[95%CI,1.25-1.45]),MACE(12.6%与6.5%;aRD,4.1%[95%CI,3.5%-4.7%];OR,1.68[95%CI,1.52-1.85]),和并发症(23.7%vs.12.1%;aRD,6.5%[95%CI,5.1%-7.9%];aOR,1.72[95%CI,1.64-1.80]),出院时残疾除外(41.1%vs.33.1%;aRD,0.4%[95%CI,-1.7%至2.5%];OR,0.99[95%CI,0.88-1.11])。
■住院缺血性中风表现出更严重的中风,更糟糕的血管风险状况,次优的管理措施,与社区发作的缺血性卒中相比,结局更差。这强调了迫切需要改善医院护理系统和有针对性的质量改进计划,以改善院内缺血性中风的预后。
■中国国家重点研发计划和北京医院管理局。
UNASSIGNED: Lack of high-quality national-level data on in-hospital ischaemic stroke hinders the development of tailored strategies for this subgroup\'s identification, treatment, and management.
UNASSIGNED: We analyzed and compared clinical characteristics, in-hospital management measures, and outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), disability at discharge, and in-hospital complications between in-hospital and community-onset ischaemic stroke enrolled in the Chinese Stroke Center Association registry from August 2015 to December 2022.
UNASSIGNED: The cohort comprised 14,948 in-hospital and 1,366,898 community-onset ischaemic stroke patients. In-hospital ischaemic stroke exhibited greater stroke severity, higher prevalence of comorbidities, more pre-admission medications, and had suboptimal management measures, for example, the onset-to-needle time within 4.5 h (83.3% vs. 93.1%; difference, -9.8% [-11.4% to -8.3%]), and antithrombotics at discharge (78.6% vs. 90.0%; difference, -11.4% [95% CI, -12.1% to -10.7%]). After adjusting for covariates, in-hospital ischaemic stroke remains associated with higher risks of unfavorable outcomes, including in-hospital death/DAMA (13.9% vs. 8.6%; adjusted risk difference [aRD], 2.2% [95% CI, 1.8%-2.7%]; adjusted odds ratio [aOR], 1.35 [95% CI, 1.25-1.45]), MACE (12.6% vs. 6.5%; aRD, 4.1% [95% CI, 3.5%-4.7%]; aOR, 1.68 [95% CI, 1.52-1.85]), and complications (23.7% vs. 12.1%; aRD, 6.5% [95% CI, 5.1%-7.9%]; aOR, 1.72 [95% CI, 1.64-1.80]), except for disability at discharge (41.1% vs. 33.1%; aRD, 0.4% [95% CI, -1.7% to 2.5%]; aOR, 0.99 [95% CI, 0.88-1.11]).
UNASSIGNED: In-hospital ischaemic stroke demonstrated more severe strokes, worse vascular risk profiles, suboptimal management measures, and worse outcomes compared to community-onset ischaemic stroke. This emphasizes the urgent need for improved hospital systems of care and targeted quality improvement initiatives for better outcomes in in-hospital ischaemic stroke.
UNASSIGNED: National Key R&D Programme of China and Beijing Hospitals Authority.