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J Neurol Neurosurg Psychiatry. 2013 Jun;84(6):596-603. doi: 10.1136/jnnp-2012-304005. Epub 2013 Jan 23.

Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study.

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1
Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de, Lleida, IRBLleida, Avda Rovira Roure, 80, Lleida 25198, Spain. fpurroygarcia@gmail.com

Abstract

BACKGROUND:

Many guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke.

OBJECTIVE:

To determine whether all patients with multiple TIAs have the same high early risk of stroke.

METHODS:

Between April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.

RESULTS:

Clinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence.

CONCLUSIONS:

According to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients.

KEYWORDS:

Cerebrovascular Disease; Stroke

PMID:
23345284
DOI:
10.1136/jnnp-2012-304005
[Indexed for MEDLINE]
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