目的:直接比较症状性颅内动脉粥样硬化性疾病(ICAD)患者的90天预后,颅外颈动脉粥样硬化疾病(ECAD),以及ICAD与伴随的ECAD。
方法:从2017年至2021年,前瞻性纳入了(1)卒中神经科医生评估的入院后30天内发生短暂性脑缺血发作或缺血性卒中以及(2)同侧ICAD和/或ECAD的患者。该队列分为三组:ICAD,ECAD,以及ICAD与伴随的ECAD。评估的主要结果是90天缺血性卒中复发。次要结果包括90天心肌梗死(MI),全因死亡率,和主要不良心血管事件(MACE,包括心血管死亡,非致死性MI,和/或非致命性缺血性中风)。
结果:在纳入分析的371例患者中,240例(64.7%)患者仅患有ICAD,93例(25.0%)患者仅有ECAD,38例(10.3%)患者患有ICAD合并ECAD。关于多变量时间到事件分析,调整潜在的混杂因素,并以ICAD作为参考比较器,90天临床结局的风险在ICAD和合并ECAD患者中最高,调整后的风险比为4.54(95%CI=1.45,14.2;p=0.006),9.32(95%CI=1.58,54.8;p=0.014),和8.52(95%CI=3.54,20.5;p<0.001)90天缺血性卒中,MI,MACE,分别。
结论:ICAD合并ECAD患者预后较差,90天缺血性卒中风险明显增高,MI,和MACE。进一步的研究应集中在评估该人群的冠状动脉粥样硬化性疾病和更深入的药物治疗上。
To directly compare the 90-day outcomes of patients with symptomatic intracranial atherosclerotic disease (ICAD), extracranial carotid atherosclerotic disease (ECAD), and ICAD with concomitant ECAD.
From 2017-2021, patients who had (1) a transient ischemic attack or ischemic stroke within 30 days of admission as evaluated by a stroke neurologist and (2) ipsilateral ICAD and/or ECAD were prospectively enrolled. The cohort was divided into three groups: ICAD, ECAD, and ICAD with concomitant ECAD. The primary outcome assessed was 90-day ischemic stroke recurrence. Secondary outcomes included 90-day myocardial infarction (MI), all-cause mortality, and major adverse cardiovascular events (MACE, including cardiovascular death, nonfatal MI, and/or nonfatal ischemic stroke).
Of 371 patients included in the analysis, 240 (64.7%) patients had ICAD only, 93 (25.0%) patients had ECAD only, and 38 (10.3%) patients had ICAD with concomitant ECAD. On multivariate time-to-event analysis adjusting for potential confounders and with ICAD as the reference comparator, the risk of 90-day clinical outcomes was highest among patients with ICAD and concomitant ECAD, with adjusted hazard ratios of 4.54 (95% CI=1.45, 14.2; p = 0.006), 9.32 (95% CI=1.58, 54.8; p = 0.014), and 8.52 (95% CI=3.54, 20.5; p < 0.001) for 90-day ischemic stroke, MI, and MACE, respectively.
Patients with ICAD and concomitant ECAD have a poorer prognosis and are at significantly higher risk for 90-day ischemic stroke, MI, and MACE. Further research should focus on the evaluation of coronary atherosclerotic disease and more intensive medical therapy in this population.