Prediction of myocardial infarction in patients with transient ischaemic attack
M B Vilanova1, G Mauri-Capdevila, J Sanahuja
1Centre d'atenció primària Igualada Nord, Consorci Sanitari de l'Anoia, Igualada, Spain.
Insights
Myocardial infarction (MI) risk after transient ischemic attack (TIA) is predicted by previous coronary heart disease and male sex. New models should include DWI and ECG abnormalities for better MI prediction post-TIA.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Risk factors for myocardial infarction (MI) following transient ischemic attack (TIA) require further definition.
- Understanding these determinants is crucial for improving patient outcomes and preventative strategies.
Purpose of the Study:
- To investigate the incidence and identify predictors of MI in patients who have experienced a TIA.
- To evaluate the efficacy of existing prognostic scores in predicting MI post-TIA.
Main Methods:
- Prospective cohort study of 628 TIA patients followed for at least six months.
- Clinical data, vascular risk factors, and etiological work-ups were collected.
- Calculated established prognostic scores and performed Cox proportional hazards multivariate analyses.
Main Results:
- The study observed a 4.5% incidence of MI and 11.0% stroke recurrence over a median follow-up of 31.2 months.
- Previous coronary heart disease (CHD) (HR 5.65) and male sex (HR 2.72) were independent predictors of MI.
- Diffusion-weighted imaging (DWI) and ECG abnormalities were significantly associated with MI.
Conclusions:
- Existing risk prediction models demonstrated poor discrimination for MI post-TIA.
- Previous CHD, male sex, DWI, and ECG abnormalities are recommended for inclusion in novel prediction models.
Background:
Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA.
Methods:
We prospectively recruited patients within 24 h of transient ischaemic cerebrovascular events between October 2006 and January 2013. A total of 628 TIA patients were followed for six months or more. MI and stroke recurrence (SR) were recorded. The duration and typology of clinical symptoms, vascular risk factors and aetiological work-ups were prospectively recorded and established prognostic scores (ABCD2, ABCD2I, ABCD3I, Essen Stroke Risk Score, California Risk Score and Stroke Prognosis Instrument) were calculated.
Results:
Twenty-eight (4.5%) MI and 68 (11.0%) recurrent strokes occurred during a median follow-up period of 31.2 months (16.1-44.9). In Cox proportional hazards multivariate analyses, we identify previous coronary heart disease (CHD) (hazard ratio [HR] 5.65, 95% confidence interval [CI] 2.45-13.04, P < 0.001) and sex male (HR 2.72, 95% CI 1.02-7.30, P = 0.046) as independent predictors of MI. Discrimination for the prognostic scores only ranged from 0.60 to 0.71. The incidence of MI did not vary among the different aetiological subtypes. Positive diffusion weighted imaging (DWI) (7.5% vs 2.5%, P = 0.007), and ECG abnormalities (Q wave or ST-T wave changes) (13.6% vs 3.6%, P = 0.001) were associated to MI.
Conclusion:
According to our results, discrimination was poor for all previous risk prediction models evaluated. Variables such as previous CHD, male sex, DWI and ECG abnormalities should be considered in new prediction models.
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