­Immediate Evaluation Reduces Risk of Recurrent Strokes

The risk of stroke after an initial transient ischemic attack (TIA) is significantly reduced when patients are evaluated within 24 hours of symptom onset, new research suggests.

Previous studies had reported a 12% to 20% risk of recurrent stroke within 3 months of a TIA event. However, treatment and management of TIA has improved greatly over the past decade.
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To clarify the current risks, the researchers followed 4583 patients who had had a TIA or minor stroke within the previous 7 days at 61 sites in 21 countries from 2009 to 2011.

The researchers assigned patients an ABCD² (age, blood pressure, clinical features, duration of TIA, and diabetes) score to determine their risk of stroke—a score of 0 showed the lowest risk, and 7 showed the highest risk.

After 1-year follow-up, researchers found that of the 78% of patients who were evaluated 24 hours after symptom onset, 6.2% had a composite cardiovascular outcome, including acute brain infarction, stenosis, or atrial fibrillation. Patients who were evaluated within 24 hours had a higher ABCD² score than those who were evaluated after 24 hours.

In addition, 1.5% of patients had a stroke within 2 days of symptom onset, 2.1% within 7 days, 2.8% within 30 days, 3.7% within 90 days, and 5.1% within 1 year.

“We observed a lower risk of cardiovascular events after TIA than previously reported,” the researchers concluded. “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.”

—Amanda Balbi

Reference:

Amarenco P, Lavallée PC, Labreuche J, et al; TIAregistry.com Investigators. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533-1542.