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Vol. 25, No. 3, 2008
Issue release date: March 2008
Section title: Original Paper
Cerebrovasc Dis 2008;25:225–233
(DOI:10.1159/000113860)

Major Vascular Events after Transient Ischaemic Attack and Minor Ischaemic Stroke: Post Hoc Modelling of Incidence Dynamics

Atanassova P.A. · Chalakova N.T. · Dimitrov B.D.
aDepartment of Neurology, Medical University, and bInformation Services Section, Medical University Hospital St. George, Plovdiv, Bulgaria

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/7/2006
Accepted: 9/18/2007
Published online: 1/24/2008

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: Only few follow-up studies have compared the long-term risk of such major vascular events (MVE) as myocardial infarction (MI) and/or stroke following transient ischaemic attack (TIA) or minor ischaemic stroke (MIS). Estimates of relative risk and cumulative long-term occurrence of MVE may provide better information and contribute to the optimization of treatment decisions. Methods: In the current post hoc modelling study with unique data from Bulgaria, we analysed 183 consecutive patients with TIA (n = 89) or MIS (n = 94), aged >40 years, who were prospectively followed over 36 months for non-fatal or fatal MVE. The cumulative survival, hazard and risks (with 95% confidence intervals) for MVE (combined or by stratification) were calculated by Kaplan-Meier analysis and adjusted (age, sex) by multivariate Cox proportional hazard models. A set of regression models was then applied to MVE incidence (per 100 patients; 4-month intervals). Results: Median follow-up was 36 months (interquartile range 30.8–36.0); no differences by age or sex were found (p > 0.05). The risk of non-fatal or fatal MVE was approximately 28% (stroke 19.7%, MI 8.2%). The adjusted cumulative risk of stroke was 0.21 versus 0.10 for MI. The odds ratio of TIA versus MIS was 0.75 (95% CI 0.43–1.32), i.e. lower for stroke (0.63, 0.31–1.25) than for MI (1.12, 0.40–3.14). The risk of non-fatal MVE was higher in MIS than in TIA (pBreslow = 0.0497), especially for non-fatal stroke (p = 0.0325). Time series regression models provided best estimates of the different outcome dynamics in TIA versus MIS (R2TIA = 0.969 with bpower = 1.04 vs. R2MIS = 0.989 with blinear = 0.84; p1-tailed = 0.04) over the study period. Conclusions: The age- and sex-adjusted cumulative 36-month hazard of MVE is higher after MIS than after TIA, but MVE fatality was higher after TIA than after MIS. Although stroke incidence was higher (up to 3 times that of MI), with the highest difference between months 8 and 18, MI fatality was always higher in absolute, relative or adjusted terms. The above alarming patterns and increasing, diverging tendencies for MVE indicate a higher long-term cumulative risk after MIS compared with TIA. These results confirm our hypothesis of a differential risk of TIA versus MIS and, at least, point toward equal importance of therapies aimed at preventing MVE in both types of preceding conditions (TIA or MIS) and the increased fatality after MI, in particular in patients with TIA.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/7/2006
Accepted: 9/18/2007
Published online: 1/24/2008

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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