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Prognosis of transient ischemic attacks in the Oxfordshire Community Stroke Project
M Dennis1, J Bamford, P Sandercock
1University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, England.
Insights
Transient ischemic attack (TIA) patients face a significantly higher risk of stroke and death. Early investigation and treatment are crucial due to the elevated risk of subsequent stroke, especially within the first year after a TIA.
Area of Science:
- Neurology
- Epidemiology
- Cardiology
Background:
- Transient ischemic attack (TIA) is a critical warning sign for future cerebrovascular events.
- Understanding the long-term prognosis and risks following a TIA is essential for patient management.
Purpose of the Study:
- To assess the prognosis and risks of death, stroke, and myocardial infarction in a community-based cohort following a transient ischemic attack.
- To compare the observed risks with expected risks in the general population.
Main Methods:
- A community-based prospective study involving approximately 105,000 individuals.
- Identification of 184 new cases of transient ischemic attack between 1981 and 1986.
- Mean follow-up of 3.7 years with data collection on mortality, stroke, and myocardial infarction.
Main Results:
- The actuarial risk of death was 6.3%/year, 1.4 times higher than expected.
- The 1-year risk of stroke was 11.6%, with a 13-fold excess risk compared to the general population.
- The 5-year risk of death, stroke, or myocardial infarction was approximately 8.4%/year.
Conclusions:
- Prognosis after TIA in this cohort was better than previously reported.
- There is a substantial and immediate excess risk of stroke following a TIA.
- Prompt medical investigation and intervention are vital for patients experiencing a TIA.
Abstract:
In a community-based study of approximately 105,000 people, 184 presented with a transient ischemic attack during the 5 years between 1981 and 1986; we believe these persons represent almost all new cases of transient ischemic attack going to a doctor during that period. During a mean follow-up of 3.7 years 49 patients died, 45 had a first-ever stroke, and 17 had a myocardial infarction. Cardiac disease accounted for 17 (35%) deaths, while stroke was the cause of death in 15 patients (31%). The average actuarial risk of death was approximately 6.3%/yr, slightly greater than that expected for similar people without transient ischemic attacks (risk ratio [observed divided by expected] = 1.4). The actuarial risk of stroke was 11.6% during the first year after a transient ischemic attack and approximately 5.9%/yr over the first 5 years. Patients who suffered a transient ischemic attack had a 13-fold excess risk of stroke during the first year and a sevenfold excess risk over the first 7 years compared with people without transient ischemic attacks. The actuarial risk of death, stroke, or myocardial infarction over the first 5 years after a transient ischemic attack was approximately 8.4%/yr. The prognosis in this community-based cohort was better than that in previous reports. The high early risk of stroke means that investigation and treatment of new cases should commence as soon as possible.