Prognostic indicators for mortality in transient ischemic attack and minor stroke

In a prospective study, 129 consecutive patients with transient ischemic attacks (TIAs) and 80 consecutive patients with minor ischemic stroke, involving the carotid artery territory in both cases, were followed-up for six years from their inclusion during the period from January 1984 to October 1985. All patients were 40–80 years old at inclusion, the median age being 74 years in the TIA group and 76 years in the minor stroke group. Overall mortality in the TIA group was significantly higher than in the minor stroke group, 44%, (57/129) vs 20% (16/80), p<0.0006 after correction for age, and that in the general population of Malmö. Pre-existing vascular disease was slightly more prevalent in the TIA than in the minor stroke group 27% (35/129 vs 21% (17/80), NS. Of the 19 patients with intermittent claudication, who all died 12 (63%) of them due to myocardial infarction (MI), 18 belonged to the TIA group and only one to the minor stroke group. The respective frequencies of the putative risk factors in the TIA and minor stroke groups were 28% (36/129) vs 9% (7/80) for hypertension (p = 0.016), 9% (12/129) vs 6% (5/80) for diabetes mellitus (NS), and 8% (10/129) vs 9% (7/80) for cardiac arrhythmia (NS). Mortality due to MI was higher in the TIA than in the minor stroke group24% (31/129) vs 6% (5/80), p = 0.001. Of the minor stroke patients, none without vascular disease died of MI. Regarding the risk of death in the study population as a whole (i.e., both groups), mortality was greater among those with vascular disease than among those without 81% (42/52) vs 20% (31/157), p = 0.0001, the corresponding figures for death due to MI being 56% (29/52) vs 4% (7/157), p = 0.0001. All six patients with both vascular disease and hypertension died, five of them due to MI. Thus, both in the TIA and minor stroke groups, mortality was greatest among those with preexisting vascular disease. To significantly reduce mortality among TIA and minor stroke patients, it is suggested that very active measures need to be taken against cardiovascular disease.