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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2012-304005
  • Cerebrovascular disease
  • Research paper

Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study

  1. on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group
  1. 1Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLLEIDA Research Institute, Lleida, Spain
  2. 2Department of Neurology, Hospital San Pedro de Alcántara de Cáceres, Cáceres, Spain
  3. 3Department of Neurology, Hospital Universitario Son Dureta, Palma de Mallorca, Spain
  4. 4Stroke Unit, Department of Neurology, Hospital Universitari Valld'Hebron, Barcelona, Spain
  5. 5Stroke Center, Department of Neurology, La Paz University Hospital, Autónoma de Madrid University, IdiPAZ Research Institute, Madrid, Spain
  6. 6Department of Neurology, Hospital ParcTaulí, Sabadell, Spain
  7. 7Department of Neurology, Hospital de Basurto, Bilbao, Spain
  8. 8Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain
  9. 9Department of Neurology, Hospital UniversitarioInfanta Cristina, Badajoz, Spain
  10. 10Stroke Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
  11. 11Stroke Unit, Hospital del Mar, Barcelona, Spain
  12. 12Department of Neurology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
  13. 13Stroke Unit, Department of Neurology, Hospital Josep Trueta, Girona, Spain
  14. 14Stroke Unit, Department of Neurology, Hospital Universitari de Bellvitge, Hospital de Llobregat, Barcelona, Spain
  15. 15Department of Neurology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
  16. 16Stroke Unit, Department of Neurology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
  17. 17Stroke Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  18. 18Stroke Unit & Stroke Program, Department of Neurology, Universitary Hospital, University of Valladolid, Valladolid, Spain
  19. 19Department of Neurology, Hospital Universitario de Albacete, Albacete, Spain
  1. Correspondence to Professor Francisco Purroy, Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de, Lleida, IRBLleida, Avda Rovira Roure, 80, Lleida 25198, Spain; fpurroygarcia{at}gmail.com
  • Received 28 August 2012
  • Revised 23 December 2012
  • Accepted 27 December 2012
  • Published Online First 23 January 2013

Abstract

Background Many guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke.

Objective To determine whether all patients with multiple TIAs have the same high early risk of stroke.

Methods Between April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.

Results Clinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence.

Conclusions According to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients.

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