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(Stroke. 2004;35:2453.)
© 2004 American Heart Association, Inc.

Original Contributions

Transient Ischemic Attacks Are More Than "Ministrokes"

From the Department of Neurology (M.D., O.M., M.H.), University Heidelberg, Universitätsklinikum Mannheim, Mannheim; and Landesärztekammer Baden-Württemberg (A.P., M.F.), Stuttgart, Germany.

Correspondence to Dr Michael Daffertshofer, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. E-mail daffertshofer{at}neuro.ma.uni-heidelberg.de

Background and Purpose— Transient ischemic attacks (TIAs) are warning signs of stroke. Recently, the hypothesis was raised that TIA bears a significant risk for death and dependence and requires the same complex diagnostic workup as a complete stroke.

Methods— We prospectively collected pre- and in-hospital procedures, symptoms, outcome, complications, and therapies from a representative sample of all stroke-treating hospitals (n=82) in southwest Germany. Follow-up was attempted 6 months after discharge. End points were death or dependence in activities of daily living (Barthel Index <95, modified Rankin Scale (mRS) of 3 to 6, or institutionalization in a nursing home).

Results— 1380 TIA patients and 3855 stroke patients entered the database. During hospital stay, stroke incidence was 8% for TIA patients and another 5% within the first half-year. Similarly, for ischemic stroke (IS) patients these figures were 7% and 6% (P>0.05), respectively. Two percent of TIA patients died in hospital (5% afterward) compared with 9% of stroke patients (10% afterward, P<0.001). Seventeen percent TIA compared with 38% IS patients (P<0.05) were dependent at follow-up. Whereas an estimated preexisting deficit (mRS >2) was the strongest predictor for death or disability (baseline mRS odds ratio, 4.1; 95% CI, 2.3 to 7.2), admission to a stroke unit was a valid predictor for survival and independence (odds ratio, 0.4; 95% CI, 0.2 to 0.9).

Conclusions— These data from a large, multicenter, nonselected, observational study underscore the "not so benign" prognosis for TIA patients. There is a relevant individual risk of early stroke, death, or disability in TIA patients. Management and treatment strategies are similar for both TIA and acute stroke.

Key Words: cerebrovascular accident • disease management • ischemic attack, transient • stroke, acute

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