Long-term cardiovascular prognosis after transient ischemic attack: Associated predictors

Abstract

Objective: To determine long-term cardiovascular risk after TIA and to identify the factors associated with increased risk.

Methods: This was a prospective observational registry of TIA patients admitted to the emergency room of our tertiary stroke center from June 2006 to January 2016. New vascular events (NVEs) were recorded from 3 months after TIA onset until June 2017, including both stroke and nonstroke events (coronary and peripheral disease). We registered TIA etiology, age, sex, vascular risk factors, radiologic data, and clinical TIA features and analyzed these variables in relation to NVE long-term risk.

Results: In total, 676 patients 71.7 ± 13.7 years of age were included, with a mean follow-up of 48.8 ± 32.7 months. An NVE was detected in 173 patients (25.6%) without significant differences between event types (p = 0.84). Univariate analysis associated NVEs with etiologic subgroup, male sex, diabetes mellitus, hypertension, previous vascular disease, duration and clinical features of TIA, and signs of acute infarction. Multivariable analysis showed an independent association of NVEs with etiologic TIA subgroup, signs of acute infarction, and duration of TIA symptoms. Large artery atherosclerosis and cardioaortic embolism had the highest NVE risk, with a slightly higher percentage of nonstroke events. The small artery disease subgroup had the lowest NVE risk, with a higher percentage of stroke events.

Conclusions: Etiology subgroup was the main factor determining high long-term risk of vascular events in patients with TIA. Large artery atherosclerosis carried the highest vascular risk, both nonstroke and stroke, followed by cardioaortic embolism.