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(Stroke. 2008;39:1717.)
© 2008 American Heart Association, Inc.

Original Contributions

Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

Angel Ois, MD; Meritxell Gomis, MD; Ana Rodríguez-Campello, MD; Elisa Cuadrado-Godia, MD; Jordi Jiménez-Conde, MD; Claustre Pont-Sunyer, MD; Gracia Cuccurella, MD Jaume Roquer, MD, PhD

From the Unitat d’Ictus. Servei de Neurologia, Hospital del Mar, Departament de Medicina, Universitat de Barcelona, IMIM-Hospital del Mar, Barcelona, Spain.

Correspondence to Angel Ois, Servicio de Neurología, Hospital del Mar, Passeig Maritim 25-29, 08003, Barcelona, Spain. E-mail 94545{at}imas imim.es

Background and Purpose— The aim of our study was to identify factors associated with stroke recurrence after an initial minor stroke or transient ischemic attack (TIA) in a prospective hospital-series.

Methods— Included in the series were 689 patients with NIHSS lower than 4 at hospital admission. The end point was a new neurological event (worsening 4 points in the initial NIHSS was considered as recurrence) at 90 days (and additionally at 7 days). Factors based on two previous reported scores (ABCD and SPI-II) were analyzed in relation with stroke recurrence: age, duration of symptoms >1 hour, weakness, speech impairment, initial hypertension, hypertension, diabetes, coronary disease, minor stroke versus TIA, prior stroke, and heart failure. We also analyzed: gender, hyperlipidemia, severe alcohol intake (>60gr/d), current smoking habits, peripheral arterial disease, atrial fibrillation, acute lesion in initial head computed tomography, severe symptomatic extra or intracranial arterial disease (SSAD; arterial stenosis 70%), previous TIA, and vertebrobasilar event. Patients were also analyzed separately according to diagnosis of TIA or minor stroke.

Results— 90-day recurrence occurred in 111 patients (16.1%), whereas 62 patients had 7-day recurrence (9%). The independent variables associated with 90-day recurrence were: SSAD (OR=4.97), weakness (OR=3.25), speech impairment (OR=1.96), severe alcohol intake (OR=4.18), heart failure (OR=2.41), previous TIA (OR=4.62), and vertebrobasilar events (OR=2.87). SSAD was independently associated with 7-day recurrence (OR=7.73) and also for TIA (OR=3.45) and minor stroke (OR=5.15) patients.

Conclusions— An arterial study to discard SSAD would be necessary, in combination with clinical factors, to improve the identification of patients with a higher risk of 90-day recurrence after an initial minor stroke or TIA.

Key Words: acute stroke • TIA • recurrence

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Early Stroke Risk After a Transient Ischemic Attack: Can It Be Minimized?

Jonathan Y. Streifler
Stroke 2008 39: 1655-1656. [Extract] [Full Text] [PDF]

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