Short-term risk and predictors of stroke after transient ischemic attack

Background and purpose:The risk of a stroke after a transient ischemic attack (TIA) is high in the short time following a TIA. The German Stroke Society recommends an early hospitalization of patients with TIA preferably in a stroke unit (SU). This study aims to compare the impact of SU care with conventional care (CC) in patients with TIA.

Methods:In a prospective study, during a 36-month phase (starting November 2007), patients with TIA who were admitted to the hospital within 48 h of symptom onset were enrolled. Stroke rate during hospitalization and the 90-day rates of stroke and mortality were studied. Logistic regression analyses were used to estimate the odds ratio (OR).

Results:Of 2,200 patients (mean age, 17.6 ± 12 years, 49% female), 1,347 (61%) treated in a SU and 853 (39%) received CC at general departments. Patients treated in SU were significantly younger than those received a CC (69.9 vs. 71.7 years; P = 0.001). TIA patients treated on SU received more ultrasound investigations of the neck arteries (98 vs. 96%; P = 0.003) and of the brain arteries (97 vs. 82%; P < 0.001) than those of CC. The primary outcomes (stroke during hospitalization, stroke after 90 days, and mortality after 90 days) did not show a difference between the SU and CC groups. In patients of male sex, the 90-day stroke rate was significantly lower in the SU group than the CC group (1.8 vs. 4.5%; P = 0.033). Using the adjusted logistic regression analysis, treatment in a SU revealed a reduction of 90-day stroke rate in patients of male sex (OR 0.38; 95% CI 0.15-0.95; P = 0.04).

Conclusion:The impact of evaluation and treatment of patients with TIA in SU and CC appears to differ only among patients of male sex. Further randomized trials are necessary.