Transient ischemic attack and minor stroke were associated with a 3.2% one-year risk of subsequent stroke, which was significantly higher than the 0.6% risk in patients with TIAMS-mimics (SHR 4.8).
Cohort (n=613)
Yes
Does true transient ischemic attack or minor stroke (TIAMS) increase the 1-year risk of subsequent stroke, TIA, MI, revascularization, or death compared to TIAMS-mimics in a community-based primary care setting?
The one-year risk of stroke after a transient ischemic attack or minor stroke in a community setting was lower than previously reported, likely due to early implementation of antiplatelet and anticoagulant therapies.
Effect estimate: SHR 4.8 (95% CI 1.04-22.3)
Absolute Event Rate: 3.2% vs 0.6%
p-value: p=0.045
Background: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5–8%. However, evidence for the outcomes of TIAMS in community care settings is limited. Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter–Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event. Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h IQR 1.8–89.9. Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.
Tomari et al. (Mon,) conducted a cohort in Transient Ischemic Attack and Minor Stroke (TIAMS) (n=613). Transient ischemic attack and minor stroke (TIAMS) vs. TIAMS-mimics was evaluated on Subsequent ischemic stroke at 1 year (SHR 4.8, 95% CI 1.04-22.3, p=0.045). Transient ischemic attack and minor stroke were associated with a 3.2% one-year risk of subsequent stroke, which was significantly higher than the 0.6% risk in patients with TIAMS-mimics (SHR 4.8).