Jeffrey J. Perry MD, MSc , Abdulaziz Alsadoon MD, MSc , Marie-Joe Nemnom MSc , Marco L.A. Sivilotti MD, MSc , Marcel Émond MD, MSc , Ian G. Stiell MD, MSc , Grant Stotts MD , Jacques S. Lee MD, MSc , Andrew Worster MD , Judy Morris MD, MSc , Ka Wai Cheung MD, MPH , Albert Y. Jin MD, PhD , Demetrios J. Sahlas MD , Heather E. Murray MD, MSc , Ariane Mackey MD , Steve Verreault MD , Marie-Christine Camden MD , Samuel Yip MD , Philip Teal MD , David J. Gladstone MD, PhD , Mukul Sharma MD, MSc
{"title":"一项多中心前瞻性队列研究,旨在识别可受益于超声心动图检查的高风险短暂性脑缺血发作/轻微脑卒中患者。","authors":"Jeffrey J. Perry MD, MSc , Abdulaziz Alsadoon MD, MSc , Marie-Joe Nemnom MSc , Marco L.A. Sivilotti MD, MSc , Marcel Émond MD, MSc , Ian G. Stiell MD, MSc , Grant Stotts MD , Jacques S. Lee MD, MSc , Andrew Worster MD , Judy Morris MD, MSc , Ka Wai Cheung MD, MPH , Albert Y. Jin MD, PhD , Demetrios J. Sahlas MD , Heather E. Murray MD, MSc , Ariane Mackey MD , Steve Verreault MD , Marie-Christine Camden MD , Samuel Yip MD , Philip Teal MD , David J. Gladstone MD, PhD , Mukul Sharma MD, MSc","doi":"10.1016/j.cjca.2024.09.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>We aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography.</div></div><div><h3>Methods</h3><div>This multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings.</div></div><div><h3>Results</h3><div>In 7149 eligible patients, a clinically significant finding was found in 556 (7.8%). There were a further 2421 (33.9%) with potentially significant findings. History of heart failure (adjusted odds ratio [OR], 3.9) or coronary artery disease (OR, 2.7) were the factors most strongly associated with clinically significant echocardiogram findings, whereas young age, male sex, valvular heart disease, and infarct (any age) on neuroimaging were modestly associated (OR, 1.3-1.9). The model combining these predictors into a score (range: 0-15), had a C-statistic of 0.67 (95% confidence interval [CI], 0.65-0.70). A cut point of 6 points or more classified 6.6% of cases as high likelihood, defined as > 15% for clinically significant echocardiogram findings.</div></div><div><h3>Conclusions</h3><div>Echocardiography is a very useful test in the investigations of patients with TIA/minor stroke. We identified high-risk clinical features—combined to create a clinical decision rule—to identify which patients with TIA/minor stroke are likely to have clinically significant echocardiogram findings requiring an immediate change in management. These patients should have echocardiography prioritized, whereas others may continue to have echocardiography conducted in a less urgent fashion.</div></div>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":"40 12","pages":"Pages 2620-2628"},"PeriodicalIF":5.8000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Multicentre Prospective Cohort Study to Identify High-Risk Transient Ischemic Attack/Minor Stroke Patients Benefitting from Echocardiography\",\"authors\":\"Jeffrey J. Perry MD, MSc , Abdulaziz Alsadoon MD, MSc , Marie-Joe Nemnom MSc , Marco L.A. Sivilotti MD, MSc , Marcel Émond MD, MSc , Ian G. Stiell MD, MSc , Grant Stotts MD , Jacques S. Lee MD, MSc , Andrew Worster MD , Judy Morris MD, MSc , Ka Wai Cheung MD, MPH , Albert Y. Jin MD, PhD , Demetrios J. Sahlas MD , Heather E. Murray MD, MSc , Ariane Mackey MD , Steve Verreault MD , Marie-Christine Camden MD , Samuel Yip MD , Philip Teal MD , David J. Gladstone MD, PhD , Mukul Sharma MD, MSc\",\"doi\":\"10.1016/j.cjca.2024.09.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>We aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography.</div></div><div><h3>Methods</h3><div>This multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings.</div></div><div><h3>Results</h3><div>In 7149 eligible patients, a clinically significant finding was found in 556 (7.8%). There were a further 2421 (33.9%) with potentially significant findings. History of heart failure (adjusted odds ratio [OR], 3.9) or coronary artery disease (OR, 2.7) were the factors most strongly associated with clinically significant echocardiogram findings, whereas young age, male sex, valvular heart disease, and infarct (any age) on neuroimaging were modestly associated (OR, 1.3-1.9). The model combining these predictors into a score (range: 0-15), had a C-statistic of 0.67 (95% confidence interval [CI], 0.65-0.70). A cut point of 6 points or more classified 6.6% of cases as high likelihood, defined as > 15% for clinically significant echocardiogram findings.</div></div><div><h3>Conclusions</h3><div>Echocardiography is a very useful test in the investigations of patients with TIA/minor stroke. We identified high-risk clinical features—combined to create a clinical decision rule—to identify which patients with TIA/minor stroke are likely to have clinically significant echocardiogram findings requiring an immediate change in management. These patients should have echocardiography prioritized, whereas others may continue to have echocardiography conducted in a less urgent fashion.</div></div>\",\"PeriodicalId\":9555,\"journal\":{\"name\":\"Canadian Journal of Cardiology\",\"volume\":\"40 12\",\"pages\":\"Pages 2620-2628\"},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0828282X24009462\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0828282X24009462","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
A Multicentre Prospective Cohort Study to Identify High-Risk Transient Ischemic Attack/Minor Stroke Patients Benefitting from Echocardiography
Background
We aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography.
Methods
This multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings.
Results
In 7149 eligible patients, a clinically significant finding was found in 556 (7.8%). There were a further 2421 (33.9%) with potentially significant findings. History of heart failure (adjusted odds ratio [OR], 3.9) or coronary artery disease (OR, 2.7) were the factors most strongly associated with clinically significant echocardiogram findings, whereas young age, male sex, valvular heart disease, and infarct (any age) on neuroimaging were modestly associated (OR, 1.3-1.9). The model combining these predictors into a score (range: 0-15), had a C-statistic of 0.67 (95% confidence interval [CI], 0.65-0.70). A cut point of 6 points or more classified 6.6% of cases as high likelihood, defined as > 15% for clinically significant echocardiogram findings.
Conclusions
Echocardiography is a very useful test in the investigations of patients with TIA/minor stroke. We identified high-risk clinical features—combined to create a clinical decision rule—to identify which patients with TIA/minor stroke are likely to have clinically significant echocardiogram findings requiring an immediate change in management. These patients should have echocardiography prioritized, whereas others may continue to have echocardiography conducted in a less urgent fashion.
期刊介绍:
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.