What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke or transient ischemic attack (n=1535). Intervention: Ischemic stroke (index event) vs. Transient ischemic attack (index event). Primary outcome: Major adverse cardiovascular events (MACE) (HR 1.32, 95% CI 1.03-1.70, p=0.029).

What does this research mean for the field?

Ischemic stroke patients have a significantly higher long-term risk of major adverse cardiovascular events and cardiovascular death compared to patients with transient ischemic attack. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 23, 2023Open Access

Long-term risk of major adverse cardiovascular events following ischemic stroke or TIA

Key Result

Ischemic stroke patients had a significantly higher long-term risk of major adverse cardiovascular events compared to transient ischemic attack patients (HR 1.32).

Study Design

Type

Cohort (n=1,535)

Multicenter

Structured PICO

Population

1535 patients discharged alive from Östersund Hospital with ischemic stroke (IS) or transient ischemic attack (TIA) between 2010 and 2013

Outcome

Composite of ischemic stroke (IS), type 1 acute myocardial infarction (AMI), and cardiovascular (CV) deathcomposite

Patients surviving an ischemic stroke or TIA face a high long-term risk of recurrent cardiovascular events, with ischemic stroke survivors at particularly higher risk for MACE and cardiovascular death compared to TIA survivors.

Main Result

Effect estimate: HR 1.32 (95% CI 1.03-1.70)

Absolute Event Rate: 39.4% vs 26.2%

p-value: p=0.029

Limitations

Use of hospital records to identify new events may have missed minor strokes and TIAs in patients who did not seek hospital care
Relatively small sample size decreases statistical power, especially in subgroup analyses
Single-center design may negatively affect external validity
Only type 1 AMIs were included, which may have led to lower event rates compared to register-based studies

Abstract

Data are scarce on long-term outcomes after ischemic stroke (IS) or transient ischemic attack (TIA). In this prospective cohort study, we examined the cumulative incidence of major adverse cardiovascular events (MACE) after IS and TIA using a competing risk model and factors associated with new events using a Cox-proportional hazard regression model. All patients discharged alive from Östersund Hospital with IS or TIA between 2010 and 2013 (n = 1535) were followed until 31 December 2017. The primary endpoint was a composite of IS, type 1 acute myocardial infarction (AMI), and cardiovascular (CV) death. Secondary endpoints were the individual components of the primary endpoint, in all patients and separated in IS and TIA subgroups. The cumulative incidence of MACE (median follow-up: 4.4 years) was 12.8% (95% CI: 11.2-14.6) within 1 year after discharge and 35.6% (95% CI: 31.8-39.4) by the end of follow-up. The risk of MACE and CV death was significantly increased in IS compared to TIA (p-values < 0.05), but not the risk of IS or type 1 AMI. Age, kidney failure, prior IS, prior AMI, congestive heart failure, atrial fibrillation, and impaired functional status, were associated with an increased risk of MACE. The risk of recurring events after IS and TIA is high. IS patients have a higher risk of MACE and CV death than TIA patients.

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