Abstract T P317: Diagnostic Imaging Performed in TIA Patients Identified in the Emergency Department: Frequency, Yield and Relationship to 90-Day Outcomes
Introduction: Patients who present to the Emergency department (ED) with transient ischemic attack (TIA) receive a wide variety of imaging tests. We describe the use, yield, and prognostic implications of diagnostic imaging undertaken in a cohort of TIA patients.
Methods: Patients with a high clinical suspicion of TIA were prospectively identified over a 12 month period in 4 community-based EDs. A TIA diagnosis was confirmed following independent physician review. Chart data were abstracted and 90-day outcomes (incident stroke, recurrent TIA, cardiovascular-related hospitalization, or death) were collected at telephone follow-up. Relative risk (RR) and 95% confidence intervals (CI) were used to quantify the association between test results and outcomes.
Results: Of 336 confirmed TIA patients, 319 (95%) had 90-day follow up data. The mean age was 66, 46% were male, 32% non-white, and 74% were hospitalized. Overall, 15% had a 90-day outcome event. Nearly all patients (98%) received brain imaging (CT and/or MRI) (Table). An acute or sub-acute infarct was identified in 4.2% of CT and 17.9% of MRI studies. Carotid artery imaging (Doppler, CTA, or MRA) was performed in 87% of patients, and stenosis >50% was found in 17%. Echocardiography (TTE and/or TEE) was performed in 66% of cases and identified potential cardioembolic sources in 12%.
Acute or sub-acute infarction on brain imaging and stenosis >50% on carotid imaging were both significantly associated with 90-day outcomes, but cardioembolic sources on echocardiography were not (Table). There was a trend towards positive MRA or Doppler studies being more strongly associated with 90-day outcomes (RR= 2.13 and 1.92, respectively) than CTA (RR= 1.16).
Conclusion: In this TIA cohort, brain, carotid artery, and cardiac imaging were all frequently acquired. Acute or sub-acute brain infarction and carotid artery stenosis were both associated with adverse outcomes at 90 days, whereas echocardiography was not.
Author Disclosures: M. Nasiri: None. J.A. Oostema: None. M. Brown: None. J. Pratt: None. M.J. Reeves: None.
- © 2014 by American Heart Association, Inc.