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- Title
Long-term outcome following attendance at a transient ischemic attack clinic.
- Authors
Cameron, Alan C.; Dawson, Jesse; Quinn, Terence J.; Walters, M.R.; McInnes, Gordon T.; Morrison, David; Sloan, William; Lees, Kennedy R.
- Abstract
Background and purpose Many patients who attend transient ischemic attack clinics have a noncerebrovascular diagnosis. The long-term outcomes in this group are not well described. We evaluated these in a cohort referred to atransient ischemic attack clinic with a suspected transientischemic attack.Methods Patients were clinically classified as having stroke or a transient ischemic attack or a noncerebrovascular diagnosis (nontransient ischemic attack). Follow-up was via electronic recordlinkage. The primary end point was cardiovasculardeath or amajor cardiovascular event. Secondary outcomes included incident neurological disease (excluding stroke or transient ischemic attack) and the need for permanent pacemaker insertion. Outcomes in the transient ischemic attack and nontransient ischemic attack cohorts were compared using Cox's proportionalhazardsmodels.Mortalityoutcomeswere further compared with those in a contemporary control group of individuals with hypertension.Results Of the 3533 patients who attended the transient ischemic attack clinic, 53.5% had a transient ischemic attack.Of these, 769 (40.7%) suffered a cardiovascular endpoint, compared with 458 (27.9%) with a nontransient ischemicattack (hazard ratio 1.53, 95% confidence interval 1.36- 1.72). The risk remained higher but was attenuated following adjustment (hazard ratio 1.21, 95% confidence interval 1.05- 1.41). Cardiovascular mortality in both groups was higherthan that in hypertensive controls. The risk of a subsequent nonstroke neurological event was higher in those without a transient ischemic attack. Conclusions Patients without a transient ischemic attack referred to a transient ischemic attack clinic have a high risk of future vascular events that exceeds risk in a cohort with hypertension. All patients attending transient ischemic attack clinics should undergo assessment of their cardiovascular risk and the use of methods to reduce this risk should be explored.
- Subjects
TRANSIENT ischemic attack; CARDIOVASCULAR disease related mortality; NEUROLOGICAL disorders; HYPERTENSION; COHORT analysis
- Publication
International Journal of Stroke, 2011, Vol 6, Issue 4, p306
- ISSN
1747-4930
- Publication type
Article
- DOI
10.1111/j.1747-4949.2011.00591.x