Physicians' Academy for Cardiovascular Education

CV risk remains high up to 5 years after TIA or minor stroke

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

Literature - Amarenco P, Lavallee PC, Monteiro Tavares L, et al. - New Engl J Med 2018; published online ahead of print

Introduction and methods

The risk of adverse outcomes in patients suffering a transient ischemic attack (TIA) or minor ischemic stroke at 1 year is elevated [1-3]. However, there are limited data on the risk of adverse outcomes beyond 1 year in these patients.

The project was designed to evaluate the short- and long-term outcomes of patients with a recent TIA or minor stroke. The short-term outcomes (at 3 months and 1 year) have been reported [3]. This analysis assessed the long-term part of the registry.

Patients aged ≥18 years with a TIA or minor stroke within the previous 7 days were enrolled in the registry from 2009 to 2011. The specifics of the cerebral ischemic events were: focal retinal or brain ischemia with resolution of symptoms or minor strokes and a score on the modified Rankin scale of 0 or 1. For this analysis, 42 out of 61 registry sites were selected, because they had available follow-up data on more than 50% of their enrolled patients at 5 years (N=3847). ABCD2 scores were calculated (range: 0-7) based on age, blood pressure, clinical findings, duration of symptoms, and presence or absence of diabetes), with higher scores indicating a greater risk of stroke.

The primary outcome was the first occurrence of a composite of CV death, non-fatal stroke (ischemic or hemorrhagic), or non-fatal acute coronary syndrome (ACS). Secondary outcomes included individual components of the primary outcome, TIA recurrence, all-cause death, bleedings according to the GUSTO definitions [4], and the modified Rankin score at last follow-up.

Main results

During the median follow-up time of 5.01 years (IQR: 4.84-5.26):

Independent predictors of recurrent stroke during years 2 to 5 were ipsilateral large-artery atherosclerosis, cardio-embolism, and an ABCD2 score ≥4.


Patients with a TIA or minor stroke in the project had a sustained elevated risk of CV events up to 5 years after the first event, whereas approximately half of the recurrent events occurred after the first year. Independent predictors of recurrent stroke (ipsilateral large-artery atherosclerosis, cardio-embolism, ABCD2 score ≥4) can be used to intensify secondary prevention in these patients, 2-5 years after the first event.


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