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N Engl J Med. 2018 Jun 7;378(23):2182-2190. doi: 10.1056/NEJMoa1802712. Epub 2018 May 16.

Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke.

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From Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Neurology and Stroke Center (P.A., P.C.L., L.M.T., J.L., P.-J.T.), and the Department of Cardiology (P.G.S.), Bichat Hospital, INSERM Laboratory for Vascular Translational Science-Unité 1148, Département Hospitalo-Universitaire Fibrose Inflammation Remodelage, Université Paris-Diderot, Sorbonne-Paris Cité, and AP-HP, Department of Biostatistics, Université Paris-Diderot, Sorbonne-Paris Cité, Fernand Widal Hospital (É.V.), Paris, and Université Lille, Centre Hospitalier Universitaire Lille, Équipe d'Accueil 2694-Santé Publique: Épidémiologie et Qualité des Soins, Lille (J.L.) - all in France; the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA (G.W.A.); the Department of Neurology, Hôtel-Dieu de France, Saint Joseph University, Beirut, Lebanon (H. Abboud); the Stroke Unit, San Camillo Hospital, Rome (S.A.); Ärztliche Leitung der Klinik für Neurologie, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin (H. Audebert), Klinik für Neurologie, Allgemeines Krankenhaus Celle, Celle (W.H.), and the Department of Neurology, Universitäts Medizin Mannheim, Heidelberg University, Heidelberg (M.G.H.) - all in Germany; Shaare Zedek Medical Center, Jerusalem, Israel (N.M.B.); the Cerebrovascular Disease Service, Beth Israel Deaconess Medical Center, Harvard University, Boston (L.R.C.); Serviço de Neurologia, Hospital de Santo António-Centro Hospitalar do Porto, Porto (M.C.), and the Department of Neurosciences, Service of Neurology, Hospital Santa Maria, University of Lisbon, Lisbon (J.M.F.) - both in Portugal; the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia (G.A.D.); the Stroke Unit and Neurology Service, University Hospital José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico (F.G.-R.); the Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin (P.J.K.); the Comprehensive Stroke Center, Palacký University and University Hospital Olomouc (M.K.), and the Department of Nursing, Faculty of Health Science, Palacký University (D.Š), Olomouc, Czech Republic; the Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan (H.-F.L.); the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona (C.M.), the Stroke Unit, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida (F.P.), and the Stroke Unit, Department of Neurology, Albacete University Hospital, Universidad de Castilla-La Mancha, Albacete (T.S.) - all in Spain; the Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea (J.M.P.); the Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford (P.M.R.), and the National Heart and Lung Institute Imperial College, Institute of Cardiovascular Medicine and Science Royal Brompton Hospital, London (P.G.S.) - both in the United Kingdom; the International University of Health and Welfare, Center for Brain and Cerebral Vessels, Sanno Hospital and Sanno Medical Center, Tokyo (S.U.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing (Y.W.); and the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (L.K.S.W.).



After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke and other vascular events is not well known. In this follow-up to a report on 1-year outcomes from a registry of TIA clinics in 21 countries that enrolled 4789 patients with a TIA or minor ischemic stroke from 2009 through 2011, we examined the 5-year risk of stroke and vascular events.


We evaluated patients who had had a TIA or minor stroke within 7 days before enrollment in the registry. Among 61 sites that participated in the 1-year outcome study, we selected 42 sites that had follow-up data on more than 50% of their enrolled patients at 5 years. The primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes (whichever occurred first), with an emphasis on events that occurred in the second through fifth years. In calculating the cumulative incidence of the primary outcome and secondary outcomes (except death from any cause), we treated death as a competing risk.


A total of 3847 patients were included in the 5-year follow-up study; the median percentage of patients with 5-year follow-up data per center was 92.3% (interquartile range, 83.4 to 97.8). The composite primary outcome occurred in 469 patients (estimated cumulative rate, 12.9%; 95% confidence interval [CI], 11.8 to 14.1), with 235 events (50.1%) occurring in the second through fifth years. At 5 years, strokes had occurred in 345 patients (estimated cumulative rate, 9.5%; 95% CI, 8.5 to 10.5), with 149 of these patients (43.2%) having had a stroke during the second through fifth years. Rates of death from any cause, death from cardiovascular causes, intracranial hemorrhage, and major bleeding were 10.6%, 2.7%, 1.1%, and 1.5%, respectively, at 5 years. In multivariable analyses, ipsilateral large-artery atherosclerosis, cardioembolism, and a baseline ABCD2 score for the risk of stroke (range, 0 to 7, with higher scores indicating greater risk) of 4 or more were each associated with an increased risk of subsequent stroke.


In a follow-up to a 1-year study involving patients who had a TIA or minor stroke, the rate of cardiovascular events including stroke in a selected cohort was 6.4% in the first year and 6.4% in the second through fifth years. (Funded by AstraZeneca and others.).

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