(Stroke. 1997;28:774-776.)
© 1997 American Heart Association, Inc.
Articles |
We Need Stronger Predictors of Major Vascular Events in Patients With a Recent Transient Ischemic Attack or Nondisabling Stroke
From the Department of Neurology, University Hospital Rotterdam (Netherlands).
Correspondence to Diederik W.J. Dippel, MD, MSc, Department of Neurology, University Hospital Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. E-mail dippel{at}neuro.fgg.eur.nl
Background It has been proposed that most prognostic factors in patients with transient ischemic attack or nondisabling stroke are weak and consequently that patients at high risk of recurrent major vascular events cannot be reliably identified.
Methods In the Dutch TIA trial, a multicenter, double-blind study of low-dose versus medium-dose aspirin, 3127 patients were included within 3 months after onset of a transient ischemic attack, amaurosis fugax, or nondisabling stroke. In a previous analysis, we developed a prediction model by means of Cox proportional hazards regression for the composite outcomes of fatal or nonfatal stroke and for myocardial infarction, stroke, or vascular death, based on clinical and demographic information as well as on the results of ancillary investigations. We assessed the discriminatory power and the calibration of the prediction models.
Results The median numbers of prognostic factors for stroke, myocardial infarction, or vascular death outcome and for stroke alone were 3 and 4, respectively. The proportion of patients with a predicted probability exceeding 30% was less than 5% for both models; here the calibration of the models was poor. Only four of the patients with stroke, myocardial infarction, or vascular death were assigned a probability of greater than 50% for that outcome, and only one of the patients with stroke was given such a high probability. The models' discriminatory ability was a little disappointing (areas under the curve of 0.73 and 0.75, respectively).
Conclusion This analysis indicates that we need stronger predictors of recurrence risk in patients with a transient ischemic attack or nondisabling stroke.
Key Words: cerebral ischemia • cerebral ischemia, transient • prognosis • risk factors
This article has been cited by other articles:
 |
|
 |
|
  P H A Halkes, L J Gray, P M W Bath, H-C Diener, B Guiraud-Chaumeil, F M Yatsu, and A Algra Dipyridamole plus aspirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk J. Neurol. Neurosurg. Psychiatry, November 1, 2008; 79(11): 1218 - 1223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Ois, M. Gomis, A. Rodriguez-Campello, E. Cuadrado-Godia, J. Jimenez-Conde, C. Pont-Sunyer, G. Cuccurella, and J. Roquer Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke Stroke, June 1, 2008; 39(6): 1717 - 1721. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. van der Lugt From Case Study to Prospective Study Stroke, November 1, 2005; 36(11): 2337 - 2338. [Full Text] [PDF]
|
|
|
|
|
|
F. Purroy, J. Montaner, A. Rovira, P. Delgado, M. Quintana, and J. Alvarez-Sabin Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions Stroke, October 1, 2004; 35(10): 2313 - 2319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T G Clark, M F G Murphy, and P M Rothwell Long term risks of stroke, myocardial infarction, and vascular death in "low risk" patients with a non-recent transient ischaemic attack J. Neurol. Neurosurg. Psychiatry, May 1, 2003; 74(5): 577 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Weimar, K. Kraywinkel, J. Rodl, A. Hippe, L. Harms, A. Kloth, H.-C. Diener, and for the German Stroke Data Bank Collaborators Etiology, Duration, and Prognosis of Transient Ischemic Attacks: An Analysis From the German Stroke Data Bank Arch Neurol, October 1, 2002; 59(10): 1584 - 1588. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K G M Moons, M L Bots, J T Salonen, P C Elwood, A Freire de Concalves, Y Nikitin, J Sivenius, D Inzitari, V Benetou, J Tuomilehto, et al. Prediction of stroke in the general population in Europe (EUROSTROKE): Is there a role for fibrinogen and electrocardiography? J Epidemiol Community Health, February 1, 2002; 56(90001): i30 - 36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Cote, C. Wolfson, S. Solymoss, A. Mackey, J. R Leclerc, D. Simard, F. Rouah, F. Bourque, and B. Leger Hemostatic Markers in Patients at Risk of Cerebral Ischemia Stroke, August 1, 2000; 31(8): 1856 - 1862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. Moroney, E. Bagiella, M. C. Paik, R. L. Sacco, and D. W. Desmond Risk Factors for Early Recurrence After Ischemic Stroke : The Role of Stroke Syndrome and Subtype Stroke, October 1, 1998; 29(10): 2118 - 2124. [Abstract] [Full Text] [PDF]
|
|