Recurrent transient ischaemic attack and early risk of stroke: data from the PROMAPA study.
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.
Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de, Lleida, IRBLleida, Avda Rovira Roure, 80, Lleida 25198, Spain. fpurroygarcia@gmail.com
Francisco
F
Purroy
Pedro Enrique
PE
Jiménez Caballero
Arantza
A
Gorospe
María José
MJ
Torres
José
J
Alvarez-Sabin
Estevo
E
Santamarina
Patricia
P
Martínez-Sánchez
David
D
Cánovas
María José
MJ
Freijo
Jose Antonio
JA
Egido
Jose M
JM
Ramírez-Moreno
Arantza
A
Alonso-Arias
Ana
A
Rodríguez-Campello
Ignacio
I
Casado
Raquel
R
Delgado-Mederos
Joan
J
Martí-Fàbregas
Blanca
B
Fuentes
Yolanda
Y
Silva
Helena
H
Quesada
Pere
P
Cardona
Ana
A
Morales
Natalia Pérez
NP
de la Ossa
Antonio
A
García-Pastor
Juan F
JF
Arenillas
Tomas
T
Segura
Carmen
C
Jiménez
Jaime
J
Masjuán
D000368:Aged; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*
Cerebrovascular Disease; Stroke