Patients who experience a transient ischemic attack (TIA) or minor stroke have a continual risk for cardiovascular events over a 5-year period following the initial event, according to a study published in the New England Journal of Medicine.

A registry of patients who experienced a TIA or minor stroke between 2009 and 2011 was used to obtain patient data on participants who were followed for up to 5 years (n=3847). The primary outcome was comprised of a composite of stroke, acute coronary syndrome, or cardiovascular-related mortality, whichever occurred first. Investigators specifically examined the rate of the primary outcome between year 2 and 5 in this cohort. Secondary outcomes included the occurrence of all-cause mortality, cardiovascular-related mortality, stroke or TIA, intracranial hemorrhage, acute coronary syndrome, or bleeding.

A total of 469 patients experienced the composite primary outcome during the 5-year follow-up study (estimated cumulative rate, 12.9%; 95% CI, 11.8-14.1). Additionally, a total of 345 patients experienced a stroke during follow-up (estimated cumulative rate, 9.5%; 95% CI, 8.5-10.5). Approximately half of composite outcome events and up to half of the stroke events occurred during the second through fifth years of the analysis (50.1% vs 43.2%, respectively).

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At 5 years, the rates of the secondary outcomes, including any recurrent stroke or TIA, death from any cause, death from cardiovascular causes, any acute coronary syndrome, intracranial hemorrhage, and major bleeding, were 16.8%, 10.6%, 2.7%, 2.4%, 1.1%, and 1.5%, respectively. In the sensitivity analysis, ipsilateral large-artery atherosclerosis, cardioembolism, and an ABCD2 score of ≥4 independently predicted recurrent stroke during years 2 through 5 of the study.

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Patients varied with regard to risk factors in both the 1-year and 5-year cohorts, likely limiting the findings.

The investigators add that their findings indicate there “may be potential for reducing recurrent strokes by ongoing secondary prevention measures.”


Amarenco P, Lavallée PC, Monteiro Tavares L, et al; for the Investigators. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;90:e1870-e1878.