在轻度中风中90天的中风复发:对试验和观察研究的系统审查和元分析
Andy Lim1,2, Henry Ma1,3, S Claiborne Johnston4
1School of Clinical Sciences at Monash Health Monash University Melbourne Victoria Australia.
Journal of the American Heart Association
|April 19, 2024
概括
在轻微缺血性中风后的90天中风复发风险为8.6%,每年下降. 这种重要的风险虽然正在下降,但在临床实践中需要持续关注.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 流行病学 流行病学
背景情况:
- 轻度缺血性中风复发风险通常与过渡性缺血性中风一起报告,缺乏具体的元分析.
- 之前的研究并未将轻度缺血性中风用于复发分析.
- 使用国家卫生研究院中风量表 (NIHSS) 严重程度得分≤5来定义轻度缺血性中风至关重要.
研究的目的:
- 为了评估90天中风复发的聚合比例,专门针对轻度缺血性中风.
- 分析轻度缺血性中风复发的趋势和影响因素.
- 提供针对轻微缺血性中风复发的聚焦元分析.
主要方法:
- 从2000年到2021年1月,在PubMed和相关文章参考列表上进行了系统的文献搜索.
- 包括随机对照试验和观察性研究报告90天中风复发在轻微的中风队列.
- 对14项精选研究 (6项RCT,8项观察性) 进行了多级随机效应元分析,涉及45462名患者.
主要成果:
- 小型缺血性中风的90天中风复发率是8.6% (95% CI,6.5-10.7).
- 脑卒中复发率每年减少0.60% (95% CI,0.09-1.1;P=0.02). 脑卒中复发率每年降低0.60% (95% CI,0.09-1.1;P=0.02). 脑卒中复发率每年降低0.6%.
- 与非双抗血小板治疗臂 (7.2%) 和观察性研究 (10.6%) 相比,双抗血小板治疗臂 (6.3%) 的复发率最低.
结论:
- 随着时间的推移,轻微缺血性中风后复发的风险正在下降.
- 尽管下降了,但90天中风复发风险仍然很大.
- 在这项分析中,年龄,高血压,糖尿病,缺血性心脏病或心房等因素与复发无显著关联.
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