Stroke risk after transient ischemic attack in a Norwegian prospective cohort

Ildstad, Fredrik; Ellekjær, Hanne; Wethal, Torgeir; Lydersen, Stian; Sund, Janne Kutschera; Fjærtoft, Hild; Schüler, Stephan; Horn, Jan-Tore H.; Bråthen, Geir; Midtsæther, Ann-Grete; Morsund, Åse Hagen; Lillebø, Marja-Liisa; Seljeseth, Yngve Müller; Indredavik, Bent

doi:10.1186/s12883-018-1225-y

Cited by 14 publications

(33 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In recent decades, several studies conducted in a wide range of different settings have focused on the association between transient ischaemic attack (TIA) and the risk of stroke [3][4][5][6][7][8][9][10][11][12][13][14]. Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged.…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, most of the recent studies followed participants for 5 years or less [7][8][9][10]13], so the long-term risk of stroke and associated predictors in patients with a history of TIA remains largely unknown. Thirdly, only one previous study was conducted in Germany [10] and, given that stroke incidence is particularly high in Germany [16], more research investigating risk factors for this neurological condition in this country is needed.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Jacob

Tanislav

Kostev³

2019

Euro J of Neurology

View full text Add to dashboard Cite

Background and purpose Little is known about the long‐term association between transient ischaemic attack (TIA) and stroke. Therefore, the goal of this study was to analyze the long‐term risk of stroke and associated predictors in a large cohort of TIA patients followed in general practices in Germany. Methods This study included patients with an initial TIA diagnosis and subsequently followed up in one of 1262 general practices in Germany between January 2007 and December 2016 (N = 19 824 patients). The primary outcome of the study was the risk of ischaemic stroke within 10 years of the initial diagnosis of TIA. The secondary outcome was the identification of demographic, clinical and pharmaceutical variables significantly associated with stroke in TIA patients. Results Within 10 years of the initial TIA diagnosis, 18.3% of individuals were diagnosed with stroke. Age was positively associated with stroke, with hazard ratios ranging from 1.88 in patients aged 51–60 years to 4.00 in those aged >80 years (reference group: patients aged ≤50 years). Furthermore, male sex, hypertension, diabetes mellitus, atrial fibrillation and ischaemic heart diseases had an additional impact on the risk of stroke. Finally, new oral anticoagulants, heparins, diuretics, angiotensin II receptor blockers and platelet aggregation inhibitors were identified as protective factors. Conclusions In a cohort of almost 20 000 TIA patients, 18.3% were diagnosed with stroke within 10 years after the TIA index event. Several demographic, clinical and pharmaceutical variables significantly predicted the long‐term risk of stroke in TIA patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Jacob

Tanislav

Kostev³

2019

Euro J of Neurology

View full text Add to dashboard Cite

show abstract

“…These results are in line with the risks described in our own prospective TIA cohort. 7 Other recent studies reporting the effect of rapid evaluation and treatment initiation of TIA patients have found similar low stroke risks. 3,4,17,18 As described earlier, 7 this trend towards a lower stroke recurrence during the recent years may be explained by more rapid evaluation by stroke specialists, better implementation of secondary stroke prevention strategies, as well as changing risk factors in the population, for instance through a decline in cigarette smoking rates.…”

Section: Discussionmentioning

confidence: 69%

“…6 In our prospective TIA study, MIDNOR TIA, we found a lower stroke risk after TIA than reported in earlier studies. 7 The ABCD2 score was able to identify patients with very low risk of stroke, but did not reliably discriminate between low and high-risk patients, suggesting that it may be less useful in populations with a general low risk of stroke after TIA. The primary aim of the present study was to investigate the predictive accuracy of the ABCD3-I score and secondary to compare it with the ABCD2 score in short-and long-term risk strati cation, and to test whether ABCDI-3 score performed better in populations with a low risk of stroke after TIA.…”

Section: Introductionmentioning

confidence: 88%

“…This is a prospective multicenter study enrolling patients with TIA, the methods of which have been described in detail previously. 7 In brief, all eight hospitals in the region of Central Norway recruited patients from October, 2012, to July, 2014, with follow-up until July, 2015. Experienced stroke physicians performed inclusion, in most cases on the hospital ward.…”

Section: Study Design and Participantsmentioning

confidence: 99%

See 1 more Smart Citation

ABCD2 and ABCD3-I scores in a TIA population with low stroke risk

Ildstad

Ellekjær

Wethal

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background Several clinical risk scores have been developed to predict stroke risk after transient ischemic attack (TIA). We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short and long-term stroke risk prediction in our post TIA stroke risk study, MIDNOR TIA. Methods We performed a prospective, multicenter study in Central Norway from October, 2012, to July, 2015, enrolling 577 patients with TIA. In a subset of patients (n=305) we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score at 1 week, 3 months and 1 year. To assess stroke occurrences, data obtained by telephone follow-up and registry data from the Norwegian Stroke Register was used. Results Three hundred and five patients had complete data for both ABCD3-I and ABCD2 scores. Within 1 week, 3 months and 1 year, 1.0% (n=3), 3.3% (n=10) and 5.2% (n=16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week (compared with ABCD2 score p =0.019), 0.66 (95% CI, 0.53 to 0.80) at 3 months ( p =0.11), and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year ( p =0.39). Conclusions The ABCD3-I score had limited value in short term prediction of subsequent stroke after TIA and did not reliably discriminate between low and high-risk patients in long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since modern treatment regimens and a decrease in risk factors in the population have contributed to a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited.

show abstract

Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke

Mendelson

Prabhakaran

2021

JAMA

447

230

View full text Add to dashboard Cite

troke is the fifth leading cause of death in the United States, with annual costs related to stroke care exceeding $70 billion. 1,2 Nearly 800 000 patients experience stroke per year in the US, of which nearly 700 000 are acute ischemic stroke (AIS). If not treated within the first hours to days with antithrombotic therapy (and carotid revascularization in those with severe carotid stenosis), 7.5% to 17.4% of patients with transient ischemic attack (TIA) experience a stroke within 3 months, with half of this risk occurring within the first 48 hours after TIA onset. 3,4 Given absence of recent epidemiologic data and evolving definitions of TIA, the incidence of TIA is less clear than for AIS but may exceed 240 000 patients annually in the US. [5][6][7] IMPORTANCE Stroke is the fifth leading cause of death and a leading cause of disability in the United States, affecting nearly 800 000 individuals annually.OBSERVATIONS Sudden neurologic dysfunction caused by focal brain ischemia with imaging evidence of acute infarction defines acute ischemic stroke (AIS), while an ischemic episode with neurologic deficits but without acute infarction defines transient ischemic attack (TIA). An estimated 7.5% to 17.4% of patients with TIA will have a stroke in the next 3 months. Patients presenting with nondisabling AIS or high-risk TIA (defined as a score Ն4 on the age, blood pressure, clinical symptoms, duration, diabetes [ABCD2] instrument; range, 0-7 [7 indicating worst stroke risk]), who do not have severe carotid stenosis or atrial fibrillation, should receive dual antiplatelet therapy with aspirin and clopidigrel within 24 hours of presentation. Subsequently, combined aspirin and clopidigrel for 3 weeks followed by single antiplatelet therapy reduces stroke risk from 7.8% to 5.2% (hazard ratio, 0.66 [95% CI, 0.56-0.77]). Patients with symptomatic carotid stenosis should receive carotid revascularization and single antiplatelet therapy, and those with atrial fibrillation should receive anticoagulation. In patients presenting with AIS and disabling deficits interfering with activities of daily living, intravenous alteplase improves the likelihood of minimal or no disability by 39% with intravenous recombinant tissue plasminogen activator (IV rtPA) vs 26% with placebo (odds ratio [OR], 1.6 [95% CI, 1.1-2.6]) when administered within 3 hours of presentation and by 35.3% with IV rtPA vs 30.1% with placebo (OR, 1.3 [95% CI, 1.1-1.5]) when administered within 3 to 4.5 hours of presentation. Patients with disabling AIS due to anterior circulation large-vessel occlusions are more likely to be functionally independent when treated with mechanical thrombectomy within 6 hours of presentation vs medical therapy alone (46.0% vs 26.5%; OR, 2.49 [95% CI,) or when treated within 6 to 24 hours after symptom onset if they have a large ratio of ischemic to infarcted tissue on brain magnetic resonance diffusion or computed tomography perfusion imaging (modified Rankin Scale score 0-2: 53% vs 18%; OR, 4.92 [95% CI,).CONCLUSIONS AND RELEVANCE D...

show abstract

Stroke risk after transient ischemic attack in a Norwegian prospective cohort

Cited by 14 publications

References 19 publications

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

ABCD2 and ABCD3-I scores in a TIA population with low stroke risk

Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke

Contact Info

Product

Resources

About