Prior transient ischemic attack is independently associated with lesser in-hospital case fatality in acute stroke.
OBJECTIVE
Ischemic preconditioning has been well established in healthy human hearts, but limited information is available about its occurrence or its integrity in the brain. The aim of the present study was therefore to investigate whether a prior cerebral ischemic episode (stroke or transient ischemic attack [TIA]) is able to confer protection against ischemic stroke, reflected by in-hospital case fatality.


METHODS
A total of 2874 acute stroke patients included in the prospective, hospital-based Debrecen Stroke Database were studied, of whom 673 had previous stroke and 195 had prior TIA.


RESULTS
Following adjustment for active confounders, TIA but not stroke in the history was associated with decreased odds for in-hospital case fatality (odds ratio, 0.53; 95% confidence interval: 0.29-0.98; P = 0.041). The fitness of the final multiple regression model was good (Hosmer-Lemeshow goodness-of-fit chi(2) statistic (P = 0.328).


CONCLUSIONS
TIA may have an ischemic preconditioning effect in the human brain.
Zsuga
Judit
J
Department of Neurology, University of Debrecen, Hungary. zsuga@king.pharmacol.dote.hu
Gesztelyi
Rudolf
R
Juhasz
Bela
B
Kemeny-Beke
Adam
A
Fekete
Istvan
I
Csiba
Laszlo
L
Bereczki
Daniel
D
D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D019194:Ischemic Preconditioning; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D020521:Stroke / Q000150:complications / Q000209:etiology / Q000401:mortality*