Influence
March 26, 2025

Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke: A Systematic Review and Meta-Analysis

Dawn Bravata, MD

Published in JAMA. Here is a link to the article.

Regenstrief Institute authors: Dawn M. Bravata, M.D.

This meta-analysis examined long-term stroke risk after a transient ischemic attack (TIA) or minor stroke. Analyzing data from 38 cohort studies involving over 171,000 patients, researchers found that stroke risk remains elevated for up to 10 years. The stroke rate was highest in the first year (5.94 events per 100 person-years), then decreased but remained steady in subsequent years (about 1.8 events per 100 person-years through year 10). The cumulative risk reached 12.5% at 5 years and 19.8% at 10 years. Stroke rates were higher in studies from North America and Asia, in more recent cohorts, and in studies using active tracking methods. Patients with only TIA or first-time events had lower stroke risks. The study highlights the need for sustained stroke prevention in patients with prior TIA or minor stroke.

Authors

Writing Committee for the PERSIST CollaboratorsFaizan Khan 1Vignan Yogendrakumar 2 3Ronda Lun 1Aravind Ganesh 1Philip A Barber 1Vasileios-Arsenios Lioutas 4Naja Emborg Vinding 5Ale Algra 6Christian Weimar 7Joachim Ögren 8Jodi D Edwards 9Richard H Swartz 10Angel Ois 11Eva Giralt-Steinhauer 11Andrej Netland Khanevski 12Xinyi Leng 13Xuan Tian 13Thomas W Leung 13Hong-Kyun Park 14Hee-Joon Bae 15Masahiro Kamouchi 16Tetsuro Ago 16Esmee Verburgt 17Jamie Verhoeven 17Frank-Erik de Leeuw 17Bernhard P Berghout 18M Kamran Ikram 18Karel Kostev 19William Whiteley 20 21Toshiyuki Uehara 22Kazuo Minematsu 23Fredrik Ildstad 24Simon Fandler-Höfler 25Karoliina Aarnio 26Bettina von Sarnowski 27Matteo Foschi 28Jing Jing 29Minyoul Baik 30Young Dae Kim 31Michele Domenico Spampinato 32Yasuhiro Hasegawa 33Kanjana Perera 21Francisco Purroy 34Dipankar Dutta 35Xiaoli Yang 36Julian Lippert 36Laura Myers 37Dawn M Bravata 37Monica Santos 38Sarah Coveney 39Carlos Garcia-Esperon 40Christopher R Levi 40Diane L Lorenzetti 41Shabnam Vatanpour 1Yongjun Wang 29Gregory W Albers 42Philippa Lavallee 43Pierre Amarenco 21 43Shelagh B Coutts 1Michael D Hill 1 44

Affiliations

1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

2Department of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.

3Division of Neurology, The Ottawa Hospital and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.

4Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

5Copenhagen University Hospital, Heart Centre, Rigshospitalet, Copenhagen, Denmark.

6Julius Center and Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.

7Institute of Medical Informatics, Biometry, and Epidemiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.

8Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden.

9University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

10University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

11Hospital del Mar Medical Research Institute, Barcelona, Spain.

12Department of Neurology, Haukeland University Hospital, Bergen, Norway.

13Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.

14Inje University Ilsan Paik Hospital, Goyang, South Korea.

15Seoul National University College of Medicine, Seoul, South Korea.

16Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

17Department of Neurology, Research Institute for Medical Research and Innovation, Radboud University Medical Centre, Nijmegen and Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, the Netherlands.

18Departments of Epidemiology and Neurology, Erasmus-MC University Medical Center Rotterdam, Rotterdam, the Netherlands.

19Epidemiology, IQVIA, Frankfurt, Germany.

20Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.

21Population Health Research Institute and McMaster University, Hamilton, Ontario, Canada.

22Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan.

23Iseikai International General Hospital, Osaka, Japan.

24Department of Medicine, Stroke Unit, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

25Department of Neurology, Medical University of Graz, Graz, Austria.

26Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

27University Medicine Greifswald, Greifswald, Germany.

28Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy.

29Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

30Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea.

31Yonsei University College of Medicine, Seoul, South Korea.

32St Anna University Hospital and University of Ferrara, Ferrara, Italy.

33St Marianna University School of Medicine, Kawasaki, Japan.

34Hospital Universitari Arnau de Vilanova de Lleida, University of Lleida, IRBLleida, Lleida, Spain.

35Gloucestershire Royal Hospital, Gloucester, United Kingdom.

36Department of Neurology, Pulmonary Medicine, Allergology, and Clinical Immunology, Inselspital, Bern University Hospital, Bern, Switzerland.

37Department of Veterans Affairs Health Systems Research, Centre for Health Information and Communication, Indianapolis, Indiana.

38Hospital Santa Maria/Centro Hospitalar Lisboa Norte, Lisbon, Portugal.

39Mater Misericordiae University Hospital, Dublin, Ireland.

40Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia.

41Department of Community Health Sciences, Cumming School of Medicine and Health Sciences Library, University of Calgary, Calgary, Alberta, Canada.

42Department of Neurology, Stanford University Medical Centre, Palo Alto, California.

43Department of Neurology and Stroke Center, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, University of Paris, Paris, France.

44Departments of Community Health Sciences, Radiology, and Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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