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

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