Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population.

IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-10-01 Epub Date: 2024-06-06 DOI:10.1177/17474930241257759
Keng Siang Lee, Isabel Siow, Tessa Riandini, Kaavya Narasimhalu, Kelvin Bryan Tan, Deidre Anne De Silva
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Abstract

Objective: There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality.

Methods: This cohort study adhered to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We obtained data from the Singapore Stroke Registry (SSR) from 2005 to 2016 and cross referenced to the Death Registry and the Myocardial Infarction Registry. Outcome measures included recurrent stroke, acute myocardial infarction (AMI), and all-cause and stroke-related deaths. Multivariable Cox proportional hazards regression models were performed to determine risk factors for recurrent stroke, AMI, and all-cause and stroke-related deaths.

Results: A total of 64,915 patients (6705 young, and 58,210 older) were included in our analysis. Older stroke patients were found to have an increased risk of recurrent stroke (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.12-1.30), AMI (HR = 1.73, 95% CI = 1.54-1.95), all-cause death (HR = 2.49, 95% CI = 2.34-2.64), and stroke-related death (HR = 176, 95% CI = 1.61-1.92). Among young stroke patients, males were at increased risk for recurrent stroke (HR = 1.18, 95% CI = 1.01-1.39) and AMI (HR = 1.41, 95% CI = 1.08-1.83), but at reduced risk for all-cause (HR = 0.78, 95% CI = 0.69-0.89) and stroke-related deaths (HR = 0.79, 95% CI = 0.67-0.94). Ethnicity appeared to influence outcomes, with Malay patients at increased risk of recurrent stroke (HR = 1.37, 95% CI = 1.14-1.65), AMI (HR = 2.45, 95% CI = 1.87-3.22), and all-cause (HR = 1.43, 95% CI = 1.24-1.66) and stroke-related deaths (HR = 1.34, 95% CI = 1.09-1.64). Indian patients were also at increased risk of AMI (HR = 1.96, 95% CI = 1.41-2.72). Similar findings were seen among the older stroke patients.

Conclusion: This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.

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多种族亚裔人群中脑卒中患者复发和预后的相关人口学因素。
目的:有关亚裔中风患者预后的研究很少。识别有较差预后风险的中风患者亚群可确定哪些患者可从有针对性的干预措施中获益。因此,本研究旨在确定哪些缺血性脑卒中患者有复发和死亡的高风险:这项队列研究遵循了《加强流行病学观察性研究的报告》(STrengthening the Reporting of OBservational studies in Epidemiology,STROBE)指南。我们从新加坡卒中登记处(SSR)获得了 2005 年至 2016 年的数据,并与死亡登记处、心肌梗死登记处进行了交叉比对。结果指标包括复发性卒中、急性心肌梗死(AMI)、全因死亡和卒中相关死亡。采用多变量考克斯比例危险回归模型确定复发性中风、急性心肌梗死、全因和中风相关死亡的风险因素:共有 64,915 名患者(6,705 名年轻患者和 58,210 名老年患者)纳入了我们的分析。发现老年中风患者复发中风(HR = 1.21,95%CI:1.12-1.30)、急性心肌梗死(HR = 1.73,95%CI:1.54-1.95)、全因死亡(HR = 2.49,95%CI:2.34-2.64)和中风相关死亡(HR = 176,95%CI:1.61-1.92)的风险增加。在年轻脑卒中患者中,男性复发脑卒中(HR = 1.18,95%CI:1.01-1.39)和急性心肌梗死(HR = 1.41,95%CI:1.08-1.83)的风险增加,但全因(HR = 0.78,95%CI:0.69-0.89)和脑卒中相关死亡(HR = 0.79,95%CI:0.67-0.94)的风险降低。种族似乎对预后有影响,马来患者复发中风(HR = 1.37,95%CI:1.14-1.65)、AMI(HR = 2.45,95%CI:1.87-3.22)、全因(HR = 1.43,95%CI:1.24-1.66)和中风相关死亡(HR = 1.34,95%CI:1.09-1.64)的风险增加。印度患者发生急性心肌梗死的风险也有所增加(HR = 1.96,95%CI:1.41-2.72)。在老年中风患者中也有类似发现:本研究发现,老年脑卒中患者的预后风险较低。特别是在年轻中风人群中,男性易患中风复发和急性心肌梗死,但可避免全因死亡和中风相关死亡。在老年中风人群中,男性全因死亡和中风相关死亡的风险也有所降低。此外,马来和印度患者在首次中风后的预后较差。需要针对这些高危人群进一步优化风险因素,以实现高质量的医疗服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
期刊最新文献
Prehospital blood pressure lowering in patients with ischemic stroke: A systematic review and meta-analysis of randomized controlled trials. Stroke recurrence after transcatheter PFO closure in patients with cryptogenic stroke. Advancing stroke safety and efficacy through early tirofiban administration after intravenous thrombolysis: The multicenter, randomized, placebo-controlled, double-blind ASSET IT trial protocol. Predictors of futile recanalization in ischemic stroke patients with low baseline NIHSS. Anticoagulation Usage and Thrombolytic Therapy in Subjects with Atrial Fibrillation Associated Ischaemic Stroke.
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