Key result
Each year over 85 after TIA or minor stroke links to ~12% higher 1-year mortality.
Why the study?
Following positive trials of DAPT for preventing vascular events in high-risk TIA or minor ischemic stroke, the authors investigated the influence of age on vascular risk factors, hospital stay, and mortality in this population.
Observational (n=10,053)
Yes
Patients with high-risk TIA or minor ischemic stroke eligible for DAPT have substantial healthcare resource utilization and high mortality rates, particularly in older age groups.
Mortality rises sharply with age after high-risk TIA or minor stroke; leaves open whether age-specific strategies can reduce this burden.
INTRODUCTION: Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. We aimed to investigate this population regarding influence of age on vascular risk factors, hospital stay and mortality. PATIENTS AND METHODS: ≥6) or minor ischemic stroke (NIHSS ≤5) eligible for DAPT, we excluded patients with atrial fibrillation, anticoagulant use, prior major bleeding, or unknown stroke severity. FINDINGS: We identified 10,053 potential DAPT-candidates (mean age 72.6 years, 45.2% female, 16.4% with TIA). With advancing age, most vascular risk factors increased. Antiplatelet treatment increased from 31.9% before the event to 95.5% after discharge. Within 1 year following index event, the proportion of patients with ≥1 re-admission increased with age (29.2% in 40-64 year-olds; 47.2% in 85-100 year-olds). All-cause death per 100 person-years was 6.9 (95% CI 6.4-7.4) within 1 year, and highest in the first 30 days (15.2; 95% CI 12.8-18.2). For each year of increased age, the risk of death increased with 3.5% (p = 0.128) in patients 40-64 years and with 11.8% (p < 0.001) in those ≥85 years. CONCLUSIONS: While in theory representing a subset of patients with mild injury, our observational study highlights substantial use of health-care resources and high mortality rates among patients with high-risk TIA or minor ischemic stroke assumed eligible for DAPT.
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Fasth et al. (2020) conducted an observational in High-risk TIA or minor ischemic stroke (n=10,053). Advancing age was evaluated on All-cause death within 1 year (11.8% risk increase per year of age in patients ≥85 years, 95% CI 6.4-7.4, p=<0.001). Advancing age in patients with high-risk TIA or minor ischemic stroke was associated with high 1-year mortality (6.9 per 100 person-years), increasing by 11.8% per year in those ≥85 years (P<0.001).
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