Prognostic Factors for Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis.

We aimed to identify prognostic factors associated with long-term risk of stroke in this patient group and estimate their population attributable fraction (PAF).

我们旨在识别与这一患者群体长期中风风险相关的预后因素，并估计它们的人群归因分数（PAF）。

Methods

A systematic reviewwas performed of MEDLINE, Embase, and Web of Science for cohort studies including patients with TIA or minor stroke that evaluated factors for subsequent stroke over a follow-up period of ≥1 year.

对 MEDLINE、Embase 和 Web of Science 进行了系统综述，检索了包括 TIA 或小卒中患者在内的队列研究，这些研究评估了随访期≥1年后的后续卒中因素。

We pooled hazard ratios adjusted for relevant confounders using random-effect meta-analysisand determined the PAF of factors based on their pooled prevalenceand adjusted hazard ratio.

我们使用随机效应荟萃分析汇总了调整了相关混杂因素的风险比，并根据汇总的患病率和调整后的风险比确定了因素的PAF（人群归因分数）。

We assessed certainty of evidence using the grading of recommendations, assessment, development, and evaluation approach.

我们使用推荐、评估、发展和评估方法（GRADE）来评估证据的确定性。

The study is registered in PROSPERO (CRD42023476551).

该研究已在国际前瞻性注册平台PROSPERO注册（CRD42023476551）。

Results

From 14 732 identified citations, we included 28 cohort studies comprising 86 810 patients with TIA or minor stroke (median age, 69 years [interquartile range, 65-71]; 52%-60% male patients).

在识别出的14,732篇文献中，我们纳入了28项队列研究，共包含86,810名TIA或小中风患者（中位年龄69岁[四分位数范围，65-71]；男性患者占52%-60%）。

Factors that had high certainty evidence of association with increased long-term risk of stroke included older age (adjusted hazard ratio, 1.04 per year increase [95% CI, 1.02-1.05]); male sex (1.25, 1.15-1.36; PAF 13.0% [95% CI, 7.8-18.7]); atrial fibrillation (1.34, 1.18-1.52; 3.8% [95% CI, 0.3-9.9]); diabetes (1.52, 1.32-1.75; 7.7%, 3.1-14.1); hypertension (1.60, 1.31-1.94; 19.3%, 8.4-31.6); ischemic heart disease (1.67, 1.28-2.18; 10.7%, 2.8-22.9); history of stroke or TIA before the index event (1.70, 1.43-2.02; 12.0%, 5.2-21.4); smoking (1.29, 1.05-1.60; 11.2%, 1.0-30.7); ABCD2 (age, blood pressure, clinical features, duration of TIA, and presence of diabetes) score of ≥4 (1.59, 1.31-1.94; 18.0%, 2.9-39.9); presence of acute infarct on neuroimaging (1.97, 1.41-2.74; 19.0%, 5.2-38.9), including diffusion-weighted imaging-positive lesions (1.86, 1.02-3.37; 14.0%, 7.0-25.0); minor stroke as index event (1.75, 1.35-2.27 versus TIA; 28.0%, 10.2-47.6); presentation with aphasia or dysarthria (1.45, 1.24-1.69; 19.2%, 0.2-53.1); presentation with paresis (1.45, 1.15-1.84; 22.0%, 3.8-43.4); and etiologic stroke subtypes, including cardioembolism (2.16, 1.53-3.05; 14.6%, 3.1-33.5), large-artery atherosclerosis (2.19, 1.68-2.86; 13.2%, 5.1-25.5), and small-vessel disease (1.69, 1.14-2.49; 16.8%, 5.0-34.3).

与增加长期中风风险相关的高确定性因素包括年龄较大（调整后的风险比为每年增加1.04 [95% 置信区间, 1.02-1.05]）；男性（1.25, 1.15-1.36；人口归因分数为13.0% [95% 置信区间, 7.8-18.7]）；房颤（1.34, 1.18-1.52；3.8% [95% 置信区间, 0.3-9.9]）；糖尿病（1.52, 1.32-1.75；7.7%，3.1-14.1）；高血压（1.60, 1.31-1.94；19.3%，8.4-31.6）；缺血性心脏病（1.67, 1.28-2.18；10.7%，2.8-22.9）；在索引事件前有中风或TIA病史（1.70, 1.43-2.02；12.0%，5.2-21.4）；吸烟（1.29, 1.05-1.60；11.2%，1.0-30.7）；ABCD2（年龄、血压、临床特征、TIA持续时间及糖尿病存在）评分≥4（1.59, 1.31-1.94；18.0%，2.9-39.9）；神经影像学上存在急性梗死（1.97, 1.41-2.74；19.0%，5.2-38.9），包括扩散加权成像阳性的病变（1.86, 1.02-3.37；14.0%，7.0-25.0）；以小中风为索引事件（1.75, 1.35-2.27 与TIA相比；28.0%，10.2-47.6）；出现失语症或构音障碍（1.45, 1.24-1.69；19.2%，0.2-53.1）；出现偏瘫（1.45, 1.15-1.84；22.0%，3.8-43.4）；以及病因学中风亚型，包括心源性栓塞（2.16, 1.53-3.05；14.6%，3.1-33.5），大动脉粥样硬化（2.19, 1.68-2.86；13.2%，5.1-25.5），和小血管疾病（1.69, 1.14-2.49；16.8%，5.0-34.3）。

Conclusions

These findings can help identify patients with a particularly enduring risk of stroke who are most likely to benefit from ongoing monitoring and treatment and facilitate the development and implementation of targeted stroke prevention strategies.

这些发现有助于识别那些长期存在中风风险的患者，他们最有可能从持续监测和治疗中受益，并促进针对性中风预防策略的开发和实施。