Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study
Por:
Purroy, F, Caballero, PEJ, Gorospe, A, Torres, MJ, Alvarez-Sabin, J, Santamarina, E, Martinez-Sanchez, P, Canovas, D, Freijo, MJ, Egido, JA, Ramirez-Moreno, JM, Alonso-Arias, A, Rodriguez-Campello, A, Casado, I, Delgado-Mederos, R, Marti-Fabregas, J, Fuentes, B, Silva, Y, Quesada, H, Cardona, P, Morales, A, de la Ossa, NP, Garcia-Pastor, A, Arenillas, JF, Segura, T, Jimenez, C, Masjuan, J
Publicada:
1 jun 2013
Resumen:
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.
Filiaciones:
Purroy, F:
Univ Lleida, Hosp Univ Arnau de Vilanova Lleida, Dept Neurol, Stroke Unit,IRBLLEIDA Res Inst, Lleida 25198, Spain
Caballero, PEJ:
Hosp San Pedro de Alcantara Caceres, Dept Neurol, Caceres, Spain
Gorospe, A:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Torres, MJ:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Alvarez-Sabin, J:
Hosp Univ ValldHebron, Dept Neurol, Stroke Unit, Barcelona, Spain
Santamarina, E:
Hosp Univ ValldHebron, Dept Neurol, Stroke Unit, Barcelona, Spain
Martinez-Sanchez, P:
Univ Autonoma Madrid, IdiPAZ Res Inst, La Paz Univ Hosp, Dept Neurol,Stroke Ctr, Madrid, Spain
Canovas, D:
Hosp ParcTauli, Dept Neurol, Sabadell, Spain
Freijo, MJ:
Hosp Basurto, Dept Neurol, Bilbao, Spain
Egido, JA:
Hosp Clin San Carlos, Dept Neurol, Madrid, Spain
Ramirez-Moreno, JM:
Hosp Univ Cristina, Dept Neurol, Badajoz, Spain
Alonso-Arias, A:
Hosp Univ Raman & Cajal, Stroke Unit, Madrid, Spain
Rodriguez-Campello, A:
Hosp del Mar, Stroke Unit, Barcelona, Spain
Casado, I:
Hosp San Pedro de Alcantara Caceres, Dept Neurol, Caceres, Spain
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Fuentes, B:
Univ Autonoma Madrid, IdiPAZ Res Inst, La Paz Univ Hosp, Dept Neurol,Stroke Ctr, Madrid, Spain
Silva, Y:
Hosp Josep Trueta, Dept Neurol, Stroke Unit, Girona, Spain
Quesada, H:
Hosp Llobregat, Hosp Univ Bellvitge, Dept Neurol, Stroke Unit, Barcelona, Spain
Cardona, P:
Hosp Llobregat, Hosp Univ Bellvitge, Dept Neurol, Stroke Unit, Barcelona, Spain
Morales, A:
Hosp Univ Virgen Arrixaca, Dept Neurol, Murcia, Spain
de la Ossa, NP:
Hosp Badalona Germans Trias & Pujol, Dept Neurol, Stroke Unit, Badalona, Spain
Garcia-Pastor, A:
Univ Gregorio Maranon, Gen Hosp, Dept Neurol, Stroke Unit, Madrid, Spain
Arenillas, JF:
Univ Valladolid, Univ Hosp, Dept Neurol, Stroke Unit, Valladolid, Spain
Univ Valladolid, Univ Hosp, Dept Neurol, Stroke Program, Valladolid, Spain
Segura, T:
Hosp Univ Albacete, Dept Neurol, Albacete, Spain
Jimenez, C:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Masjuan, J:
Hosp del Mar, Stroke Unit, Barcelona, Spain
|