Computed Tomography Identifies Patients at High Risk for Stroke After Transient Ischemic Attack/Nondisabling Stroke Prospective, Multicenter Cohort Study

被引：24

作者：

Wasserman, Jason K. ^{[1
,2
]}

Perry, Jeffrey J. ^{[2
,3
]}

Sivilotti, Marco L. A. ^{[6
]}

Sutherland, Jane ^{[9
]}

Worster, Andrew ^{[10
]}

Emond, Marcel ^{[13
]}

Jin, Albert Y. ^{[7
]}

Oczkowski, Wieslaw J. ^{[11
]}

Sahlas, Demetrios J. ^{[11
]}

Murray, Heather ^{[8
]}

MacKey, Ariane ^{[14
]}

Verreault, Steve ^{[14
]}

Wells, George A. ^{[4
]}

Dowlatshahi, Dar ^{[2
,5
]}

Stotts, Grant ^{[5
]}

Stiell, Ian G. ^{[2
,3
]}

Sharma, Mukul ^{[12
]}

机构：

[1] Univ Ottawa, Dept Pathol & Lab Med, Ottawa, ON, Canada

[2] Univ Ottawa, Ottawa Hosp Hlth Res Inst, Ottawa, ON, Canada

[3] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada

[4] Univ Ottawa, Dept Epidemiol & Community Med, Ottawa, ON, Canada

[5] Univ Ottawa, Div Neurol, Ottawa, ON, Canada

[6] Queens Univ, Dept Emergency Med & Pharmacol & Toxicol, Kingston, ON, Canada

[7] Queens Univ, Dept Neurol, Kingston, ON, Canada

[8] Queens Univ, Dept Emergency Med, Kingston, ON, Canada

[9] Ottawa Hosp Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada

[10] McMaster Univ, Dept Neurol, Div Emergency Med, Hamilton, ON, Canada

[11] McMaster Univ, Dept Neurol, Div Neurol, Hamilton, ON, Canada

[12] McMaster Univ, Dept Neurol, Populat Hlth Res Inst, Hamilton, ON, Canada

[13] Univ Laval, Dept Emergency Med, Quebec City, PQ, Canada

[14] Hop Enfants Jesus, Dept Neurol, Quebec City, PQ, Canada

来源：

STROKE | 2015年 / 46卷 / 01期

基金：

加拿大健康研究院;

关键词：

brain infarction; stroke; tomography scanners; x-ray; computed; transient ischemic attack; SHORT-TERM PROGNOSIS; EMERGENCY-DEPARTMENT; MINOR STROKE; PROSPECTIVE VALIDATION; ATTACK; LEUKOARAIOSIS; SCORE; INFARCTION; PREDICT; TIA;

D O I：

10.1161/STROKEAHA.114.006768

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Ischemia on computed tomography (CT) is associated with subsequent stroke after transient ischemic attack. This study assessed CT findings of acute ischemia, chronic ischemia, or microangiopathy for predicting subsequent stroke after transient ischemic attack. Methods-This prospective cohort study enrolled patients with transient ischemic attack or nondisabling stroke that had CT scanning within 24 hours. Primary outcome was subsequent stroke within 90 days. Secondary outcomes were stroke at <= 2 or >2 days. CT findings were classified as ischemia present or absent and acute or chronic or microangiopathy. Analysis used Fisher exact test and multivariate logistic regression. Results-A total of 2028 patients were included; 814 had ischemic changes on CT. Subsequent stroke rate was 3.4% at 90 days and 1.5% at <= 2 days. Stroke risk was greater if baseline CT showed acute ischemia alone (10.6%; P=0.002), acute+chronic ischemia (17.4%; P=0.007), acute ischemia+microangiopathy (17.6%; P=0.019), or acute+chronic ischemia+microangiopathy (25.0%; P=0.029). Logistic regression found acute ischemia alone (odds ratio [OR], 2.61; 95% confidence interval [CI[, 1.22-5.57), acute+chronic ischemia (OR, 5.35; 95% CI, 1.71-16.70), acute ischemia+microangiopathy (OR, 4.90; 95% CI, 1.33-18.07), or acute+chronic ischemia+microangiopathy (OR, 8.04; 95% CI, 1.52-42.63) was associated with a greater risk at 90 days, whereas acute+chronic ischemia (OR, 10.78; 95% CI, 2.93-36.68), acute ischemia+microangiopathy (OR, 8.90; 95% CI, 1.90-41.60), and acute+chronic ischemia+microangiopathy (OR, 23.66; 95% CI, 4.34-129.03) had greater risk at <= 2 days. Only acute ischemia (OR, 2.70; 95% CI, 1.01-7.18; P=0.047) was associated with a greater risk at >2 days. Conclusions-In patients with transient ischemic attack/nondisabling stroke, CT evidence of acute ischemia alone or acute ischemia with chronic ischemia or microangiopathy was associated with increased subsequent stroke risk within 90 days.

引用

页码：114 / 119

页数：6

共 30 条

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