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Prognostic indicators for mortality in transient ischemic attack and minor stroke
P Falke1, F Lindgärde, L Stavenow
1Department of Medicine, University of Lund, Malmö General Hospital, Sweden.
Insights
Patients experiencing transient ischemic attacks (TIAs) face significantly higher mortality than those with minor ischemic stroke. This highlights the critical need for understanding TIA prognosis and cardiovascular risk factors.
Area of Science:
- Neurology
- Cardiology
- Epidemiology
Background:
- Transient ischemic attacks (TIAs) and minor ischemic strokes are critical indicators of cerebrovascular disease.
- Understanding long-term outcomes and mortality differences between TIA and minor stroke is crucial for patient management.
Purpose of the Study:
- To compare the six-year mortality and risk factor prevalence in patients with TIAs versus minor ischemic strokes.
- To investigate causes of death, particularly myocardial infarction (MI), in relation to pre-existing vascular disease.
Main Methods:
- Prospective follow-up study of 129 TIA patients and 80 minor ischemic stroke patients over six years.
- Inclusion criteria: patients aged 40-80 years with carotid artery territory events.
- Data collected on demographics, vascular disease, risk factors (hypertension, diabetes, arrhythmia), and mortality causes.
Main Results:
- Overall mortality was significantly higher in the TIA group (44%) compared to the minor stroke group (20%) after age correction.
- Mortality due to myocardial infarction (MI) was substantially higher in the TIA group (24%) versus the minor stroke group (6%).
- Intermittent claudication was strongly associated with mortality in the TIA group, with 18 of 19 such patients dying, primarily from MI.
Conclusions:
- TIAs are associated with a significantly worse prognosis and higher mortality than minor ischemic strokes.
- Hypertension was a more frequent risk factor in the TIA group.
- Pre-existing vascular disease, particularly intermittent claudication, portends a grave prognosis in TIA patients, often linked to fatal MI.
Abstract:
In a prospective study, 129 consecutive patients with transient ischemic attacks (TIAs) and 80 consecutive patients with minor ischemic stroke, involving the carotid artery territory in both cases, were followed-up for six years from their inclusion during the period from January 1984 to October 1985. All patients were 40-80 years old at inclusion, the median age being 74 years in the TIA group and 76 years in the minor stroke group. Overall mortality in the TIA group was significantly higher than in the minor stroke group, [44%, (57/129) vs 20% (16/80), p < 0.0006 after correction for age], and that in the general population of Malmö. Pre-existing vascular disease was slightly more prevalent in the TIA than in the minor stroke group [27% (35/129 vs 21% (17/80), NS]. Of the 19 patients with intermittent claudication, who all died [12 (63%) of them due to myocardial infarction (MI)], 18 belonged to the TIA group and only one to the minor stroke group. The respective frequencies of the putative risk factors in the TIA and minor stroke groups were 28% (36/129) vs 9% (7/80) for hypertension (p = 0.016), 9% (12/129) vs 6% (5/80) for diabetes mellitus (NS), and 8% (10/129) vs 9% (7/80) for cardiac arrhythmia (NS). Mortality due to MI was higher in the TIA than in the minor stroke group[24% (31/129) vs 6% (5/80), p = 0.001]. Of the minor stroke patients, none without vascular disease died of MI.(ABSTRACT TRUNCATED AT 250 WORDS)