One-year prognosis of transient ischemic attacks with nonfocal symptoms

A few studies suggested an increased risk of stroke or coronary heart disease in patients with transient ischemic attacks (TIA) presenting with nonfocal symptoms. We aimed to assess the vascular prognosis of TIA patients with and without accompanying nonfocal symptoms.

Observational study of consecutive patients with TIA referred to a TIA Clinic from March 2004 to March 2011. Primary outcome was the composite of any event: stroke, TIA, myocardial infarction (MI) or vascular death in the first year of follow-up; secondary outcomes included individual components of the primary outcome. Hazard ratios were calculated with Cox regression.

429 TIA patients were enrolled, 329 (76.7 %) with only focal symptoms, and 100 (23.3 %) with both focal and nonfocal symptoms. In the first year after TIA, the primary outcome occurred in 65 patients (16.0 %; 95 % CI, 12 %-19 %): stroke, in 28 patients; TIA, in 31 patients; MI and vascular death in two patients each. The frequency of the composite outcome was similar in patients with or without nonfocal symptoms (16 events (17.0 %; 95 % CI, 10-24) vs. 49 events (15.7 %; 95 % CI, 12-20 %); p = 0.430). There were no significantly differences in the frequency of any of the secondary outcomes between patients with or without nonfocal symptoms.

Almost one-fourth of TIA patients reported concomitant nonfocal symptoms, but they had the same risk of stroke and cardiovascular events as patients with isolated focal symptoms.