title: Long-term outcome following attendance at a transient ischemic attack clinic.
abstract: OBJECTIVE
  Many patients who attend transient ischemic attack clinics have a noncerebrovascular diagnosis. The long-term outcomes in this group are not well described. We evaluated these in a cohort referred to a transient ischemic attack clinic with a suspected transient ischemic attack.
  
  
  METHODS
  Patients were clinically classified as having stroke or a transient ischemic attack or a noncerebrovascular diagnosis (nontransient ischemic attack). Follow-up was via electronic record linkage. The primary endpoint was cardiovascular death or a major cardiovascular event. Secondary outcomes included incident neurological disease (excluding stroke or transient ischemic attack) and the need for permanent pacemaker insertion. Outcomes in the transient ischemic attack and nontransient ischemic attack cohorts were compared using Cox's proportional hazards models. Mortality outcomes were further compared with those in a contemporary control group of individuals with hypertension.
  
  
  RESULTS
  Of the 3533 patients who attended the transient ischemic attack clinic, 53.5% had a transient ischemic attack. Of these, 769 (40.7%) suffered a cardiovascular endpoint, compared with 458 (27.9%) with a nontransient ischemic attack (hazard ratio 1.53, 95% confidence interval 1.36-1.72). The risk remained higher but was attenuated following adjustment (hazard ratio 1.21, 95% confidence interval 1.05-1.41). Cardiovascular mortality in both groups was higher than that in hypertensive controls. The risk of a subsequent nonstroke neurological event was higher in those without a transient ischemic attack.
  
  
  CONCLUSIONS
  Patients without a transient ischemic attack referred to a transient ischemic attack clinic have a high risk of future vascular events that exceeds risk in a cohort with hypertension. All patients attending transient ischemic attack clinics should undergo assessment of their cardiovascular risk and the use of methods to reduce this risk should be explored.
authors: Division of Cardiovascular and Medical Sciences, Gardiner Institute, Faculty of Medicine, University of Glasgow, Glasgow, UK.
authors: Alan C
authors: AC
authors: Cameron
authors: Jesse
authors: J
authors: Dawson
authors: Terence J
authors: TJ
authors: Quinn
authors: M R
authors: MR
authors: Walters
authors: Gordon T
authors: GT
authors: McInnes
authors: David
authors: D
authors: Morrison
authors: William
authors: W
authors: Sloan
authors: Kennedy R
authors: KR
authors: Lees