Stroke Risk After Ischemic Ocular Events: A Real-World Study of an Electronic Health Record Database

Acute ischemic ocular events (IOEs), including retinal artery occlusion (RAO) and amaurosis fugax, pose significant risk for impending ischemic stroke (IS) or transient ischemic attack (TIA). The objective is to investigate clinical characteristics that impact IS/TIA risk following the first RAO or amaurosis fugax among adult patients. Case-control study. The Truveta Electronic Health Record database was used to identify patients with incident IOE diagnosed between January 1, 2019 and September 30, 2024. Logistic regression was applied to estimate odds ratios (ORs) for potential risk factors, including baseline demographics and comorbidities at or before the IOE. The occurrence of a stroke (IS or TIA) within one year following the IOE. Of 11,297 individuals with an IOE (mean age 69.7±12.8 years; 53.7% female), 1548 (13.5%) had an IS, 1231 a TIA (10.9%), and 22.8% an IS and/or TIA (IS/TIA). IS/TIA occurred on the same day as the IOE in 9.4% of individuals. Older age (OR every 10 years: 1.11; 95% CI: 1.00–1.11), hypertension (OR: 1.99; 95% CI: 1.06-1.32), cardiovascular disease without history of MI (OR: 1.89; 95% CI: 1.62-2.22), and carotid artery stenosis (CAS; OR: 1.60; 95% CI: 1.42-1.80) carried increased risk for IS/TIA when adjusting for other characteristics. In the IS cohort, older age (OR every 10 years: 1.11; 95% CI: 1.00-1.22), CAS (OR: 1.75; 95% CI: 1.52-2.02) and hypertension (OR: 1.36; 95% CI: 1.18-1.58) also carry increased risk, along with ischemic heart disease (OR: 1.23; 95% CI: 1.08-1.40) and peripheral vascular disease (OR: 1.18; 95% CI: 1.02-1.37). In the TIA cohort, older age (OR every 10 years: 1.11; 95% CI: 1.11–1.22), cardiovascular disease without history of MI (OR: 4.88; 95% CI: 3.57-6.87), and CAS (OR: 1.46; 95% CI: 1.24-1.71) were associated with greater risk. Patients with IOEs are at significant risk for IS/TIA, with a high rate of diagnosis within 30 days after the IOE. Older age, underlying cardiovascular disease, CAS, and hypertension notably increased vulnerability to events. This highlights the need for not only immediate work-up but also close follow-up of those with IOEs, especially with these risk factors.