加拿大TIA评分前瞻性验证短暂性脑缺血发作后中风风险的准确性较高
2021-02-09   阅读:580   来源:英国医学杂志

加拿大渥太华大学Jeffrey J Perry团队比较了加拿大TIA评分与ABCD2和ABCD2i前瞻性验证短暂性脑缺血发作后中风的效果。2021年2月4日,该成果发表在《英国医学杂志》上。

为了验证先前获得的加拿大TIA评分,在急诊科短暂性脑缺血发作患者的新队列中,对后续中风风险分层的效果,研究组在加拿大的13个急诊科进行了一项长达5年的前瞻性队列研究。共招募了7607名短暂性脑缺血发作或轻微中风的成年患者。主要结局为7天内后续中风或颈动脉内膜切除术/颈动脉支架置入术。

在7607例患者中,108例(1.4%)在7天内发生了后续中风,83例(1.1%)在7天内进行了颈动脉内膜切除术/颈动脉支架置入术,9例同时进行了这两种手术。加拿大TIA评分将7天内中风、颈动脉内膜切除术/颈动脉支架置入术的风险分为低风险(风险≤0.5%)、中风险(风险2.3%)和高风险(风险5.9%),曲线下面积为0.70,比ABCD2(0.60)或ABCD2i(0.64)更准确。无论7天内是否进行颈动脉内膜切除术/颈动脉支架置入术,后续卒中的结局均相似。

研究结果表明,加拿大TIA评分对患者7天内发生中风风险进行分层的预测准确性较高,无论其是否进行了颈动脉内膜切除术/颈动脉支架置入术,值得临床推广。

附:英文原文

Title: Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study

Author: Jeffrey J Perry, Marco L A Sivilotti, Marcel émond, Ian G Stiell, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather E Murray, Ariane Mackey, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J Gladstone, Mark I Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitlebaum, Kasim Abdulaziz, Marie-Joe Nemnom, George A Wells, Mukul Sharma

Issue&Volume: 2021/02/04

Abstract:

Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack.

Design Prospective cohort study.

Setting 13 Canadian emergency departments over five years.

Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke.

Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit.

Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days.

Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.

DOI: 10.1136/bmj.n49

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