Risk factors and secondary prevention interventions for recurrence of acute cerebral infarction within half a year after rhTNK-tPA treatment

Abstract

Objective: To investigate the risk factors for the recurrence of acute cerebral infarction (ACI) within half a year after treatment with recombinant human TNK tissue-type plasminogen activator (rhTNK- tPA) and secondary prevention.

Methods: A total of 84 patients with ACI treated with rhTNK-tPA in our hospital from March 2023 to April 2024 were selected for the study. The patients were divided into a recurrence group and a non-recurrence group according to whether they recurred within half a year after treatment. The clinical data of the two groups of patients were compared, and the risk factors of recurrent cerebral infarction were analyzed. The risk prediction model of the nomogram was constructed by incorporating the risk factors and its effectiveness was verified. Model discrimination was assessed by using the receiver operating characteristic curve (ROC). Model fit was evaluated with calibration curves. Hosmer-Lemeshow (HL) analysis was applied to assess model consistency. At the same time, the effect of secondary prevention on the recurrence rate was explored.

Results: There were 20 patients with a recurrence of ACI, and the recurrence rate was 23.81%. Multivariate Logistic regression analysis showed that the risk factors of recurrence in patients with ACI included age ≥ 70 years, smoking, hypertension, diabetes, irregular or never using antiplatelet drugs (P<0.05). The prediction model of the nomogram was constructed according to the above indexes. The area under the curve (AUC) of the model’s training and test sets for predicting recurrence within six months in patients with acute cerebral infarction was 0.918 (95%CI: 0.848-0.988) and 0.850 (95%CI: 0.703-0.997). At the same time, the HL test showed good goodness of fit (χ2 =1.684, P = 0.989). The calibration curves indicated good agreement between the predicted values of the nomograms and the actual observed values. The recurrence rate of ACI patients who took secondary prevention measures was lower than that of patients who did not take corresponding measures (P<0.05).

Conclusions: Patients with ACI have a high recurrence rate within half a year. Age ≥70 years, smoking, hypertension, diabetes, irregular or never use of antiplatelet drugs are risk factors for recurrence. The prediction model of nomogram combined with 5 indicators can be used as an accurate and rapid clinical evaluation tool. The recurrence rate can be reduced by taking corresponding secondary prevention interventions for patients.