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One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke

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Issue date
2016
Author
Amarenco, Pierre
Lavallée, Philippa C.
Labreuche, Julien
Albers, Gregory W.
Bornstein, Natan M.
Canhão, Patrícia
Caplan, Louis R.
Donnan, Geoffrey A.
Ferro, José M.
Hennerici, Michael G.
Molina, Carlos
Rothwell, Peter M.
Sissani, Leila
Školoudík, David
Steg, Philippe Gabriel
Touboul, Pierre-Jean
Uchiyama, Shinichiro
Vicaut, Éric
Wong, Lawrence K.S
Purroy Garcia, Francisco
Other authors
the TIAregistry.org Investigators
Suggested citation
Amarenco, Pierre; Lavallée, Philippa C.; Labreuche, Julien; Albers, Gregory W.; Bornstein, Natan M.; Canhão, Patrícia; ... Purroy Garcia, Francisco. (2016) . One-Year Risk of Stroke after Transient Ischemic Attack or Minor Stroke. The New England Journal of Medicine, 2016, núm. 374, p. 1533-1542. https://doi.org/10.1056/NEJMoa1412981.
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Abstract
BACKGROUND Previous studies conducted between 1997 and 2003 estimated that the risk of stroke or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. The TIAregistry.org project was designed to describe the contemporary profile, etiologic factors, and outcomes in patients with a TIA or minor ischemic stroke who receive care in health systems that now offer urgent evaluation by stroke specialists. METHODS We recruited patients who had had a TIA or minor stroke within the previous 7 days. Sites were selected if they had systems dedicated to urgent evaluation of patients with TIA. We estimated the 1-year risk of stroke and of the composite outcome of stroke, an acute coronary syndrome, or death from cardiovascular causes. We also examined the association of the ABCD2 score for the risk of stroke (range, 0 [lowest risk] to 7 [highest risk]), findings on brain imaging, and cause of TIA or minor stroke with the risk of recurrent stroke over a period of 1 year. RESULTS From 2009 through 2011, we enrolled 4789 patients at 61 sites in 21 countries. A total of 78.4% of the patients were evaluated by stroke specialists within 24 hours after symptom onset. A total of 33.4% of the patients had an acute brain infarction, 23.2% had at least one extracranial or intracranial stenosis of 50% or more, and 10.4% had atrial fibrillation. The Kaplan–Meier estimate of the 1-year event rate of the composite cardiovascular outcome was 6.2% (95% confidence interval, 5.5 to 7.0). Kaplan–Meier estimates of the stroke rate at days 2, 7, 30, 90, and 365 were 1.5%, 2.1%, 2.8%, 3.7%, and 5.1%, respectively. In multivariable analyses, multiple infarctions on brain imaging, large-artery atherosclerosis, and an ABCD2 score of 6 or 7 were each associated with more than a doubling of the risk of stroke. CONCLUSIONS We observed a lower risk of cardiovascular events after TIA than previously reported. The ABCD2 score, findings on brain imaging, and status with respect to large-artery atherosclerosis helped stratify the risk of recurrent stroke within 1 year after a TIA or minor stroke. (Funded by Sanofi and Bristol-Myers Squibb.)
URI
http://hdl.handle.net/10459.1/65680
DOI
https://doi.org/10.1056/NEJMoa1412981
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The New England Journal of Medicine, 2016, núm. 374, p. 1533-1542
European research projects
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