Risk of Ischemic Stroke After Transient Ischemic Attack in Patients Receiving Comprehensive Versus Noncomprehensive...

Although a timely comprehensive diagnostic workup is recommended for patients with transient ischemic attack (TIA), few studies have examined its impact on post-TIA ischemic stroke risk. In this study, we hypothesized that patients receiving more comprehensive diagnostic workup have better outcomes, regardless of their care setting.

Studies on the workup process of patients with TIA and the 90-day post-TIA ischemic stroke incidence were searched. Eligible studies were scored 1 to 4 based on the number of diagnostic workups (head computed tomography scan, brain magnetic resonance imaging, and cerebrovascular imaging) and the involvement of a neurology provider in the diagnosis process.

Thirty-eight studies were included for meta-analysis. The overall 90-day post-TIA ischemic stroke risk was estimated to be 5% (95% CI, 4.9%-5.1%). Our meta-analysis showed that studies with higher scores-provided more comprehensive diagnostic workups by neurology providers-had a lower risk of 90-day post-TIA ischemic stroke (P<0.001). The post-TIA ischemic stroke risk was 8.4% (95% CI, 6.4%-10.8%) among studies with a score of "1, 5.3% (95% CI, 5.2%-5.5%) among studies with a score of 2, 2.9% (95% CI: 2.7%-3.2%) among studies with a score of 3, and 3.2% (95% CI, 2.5%-4%) among studies with a score of 4. The difference between studies with a score of 3 and "4 was not statistically significant (P=0.524). Moreover, studies with more comprehensive cardiac examinations had lower 90-day post-TIA ischemic stroke risk (P<0.001).

Our findings highlight that a more comprehensive diagnostic workup-neuroimaging, cerebrovascular studies, and cardiac examinations-of patients with TIA delivered by neurology providers might improve their outcomes by reducing the risk of 90-day post-TIA ischemic stroke, regardless of the care setting.