大动脉形斑块和复发性中风和死亡的风险
Marco R Di Tullio1, Cesare Russo, Zhezhen Jin
1Division of Cardiology, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA. md42@columbia.edu
Circulation
|April 22, 2009
概括
大型大动脉斑增加中风风险,特别是在密码性中风患者中. 在为期2年的研究中,华法林和阿司匹林等抗血栓性疗法并没有降低这种风险.
科学领域:
- 心血管医学 心血管医学
- 神经学 神经学
- 临床试验 临床试验
背景情况:
- 大动脉板是已知的缺血性中风风险因素.
- 怀疑是血栓栓塞机制,但缺乏对抗血栓效果的随机试验.
研究的目的:
- 调查大动脉形斑块特征与复发性中风或死亡之间的关系.
- 评估华法林与阿司匹林在中风和大动脉斑块患者中的有效性.
主要方法:
- 在516名缺血性中风患者中进行的一项随机双盲研究 (Cryptogenic Stroke Study/Warfarin-Aspirin Recurrent Stroke Study中的Patent Foramen Ovale).
- 经食道心声学评估了斑块厚度和形态.
- 患者接受了华法林或阿司匹林治疗,进行了2年的随访,监测复发性缺血性中风或死亡.
主要成果:
- 大型斑块 (>=4毫米) 在19.6%的患者中被发现; 大型复杂斑块在8.5%中.
- 大型斑块显著增加事件风险 (HR 2.12),复杂形态进一步增加风险 (HR 2.55).
- 这种风险在密码性中风患者中最大,这些患者具有大型复杂斑块 (HR 9.50). 华法林和阿司匹林组的事件发生率相似.
结论:
- 大型大动脉斑块,特别是具有复杂形态的斑块,与更高的复发性中风和死亡风险有关.
- 尽管使用华法林或阿司匹林治疗,这种增加的风险仍然存在,特别是在密码性中风患者中.
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