title: How predictors and patterns of stroke recurrence after a TIA differ during the first year of follow-up.
abstract: The highest risk of subsequent stroke after a TIA occurs within the first week after the index event. However, the risk of stroke recurrence (SR) remains high during the first year of follow-up. We studied the temporal pattern and predictors of SR (at 7 days and from 7 days to 1-year follow-up). Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). We determined the short-term (at 7 days) and long-term (from 8 days to 1 year) risk of SR. Patients who underwent short-term recurrence and long-term recurrence were compared with regard to clinical findings, vascular territories, and etiology. Enough information (clinical variables and extracranial vascular imaging) was assessed in 1,137 (90.6 %) patients. The 7-day stroke risk was 2.6 %. 32 (3.0 %) patients had an SR after 7-day follow-up. Multiple TIA (HR 3.50, 1.67-7.35, p = 0.001) and large artery atherosclerosis (HR 2.51, 1.17-5.37, p = 0.018) were independent predictors of early SR, whereas previous stroke (HR 1.40, 1.03-1.92, p = 0.034) and coronary heart disease (2.65, 1.28-5.50, p = 0.009) were independent predictors of late SR. Notoriously, 80 % of SR happened in the same territory of the index TIA at 7-day follow-up, whereas only 38 % during the long-term follow-up (p < 0.001). Different predictors of SR were identified throughout the follow-up period. Moreover, the ischemic mechanism differed in early and late stroke recurrences.
authors.affiliation: Stroke Unit, Department of Neurology, IRBLLEIDA Research Institute, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, Avda Rovira Roure, 80, 25198, Lleida, Spain, fpurroygarcia@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Purroy
authors.forename: P E
authors.initials: PE
authors.lastname: Jiménez Caballero
authors.forename: A
authors.initials: A
authors.lastname: Gorospe
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.forename: J
authors.initials: J
authors.lastname: Alvarez-Sabin
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: D
authors.initials: D
authors.lastname: Cánovas
authors.forename: M
authors.initials: M
authors.lastname: Freijo
authors.forename: J A
authors.initials: JA
authors.lastname: Egido
authors.forename: J M
authors.initials: JM
authors.lastname: Ramírez-Moreno
authors.forename: A
authors.initials: A
authors.lastname: Alonso-Arias
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez-Campello
authors.forename: I
authors.initials: I
authors.lastname: Casado-Naranjo
authors.forename: J
authors.initials: J
authors.lastname: Martí-Fàbregas
authors.forename: Y
authors.initials: Y
authors.lastname: Silva
authors.forename: P
authors.initials: P
authors.lastname: Cardona
authors.forename: A
authors.initials: A
authors.lastname: Morales
authors.forename: A
authors.initials: A
authors.lastname: García-Pastor
authors.forename: J F
authors.initials: JF
authors.lastname: Arenillas
authors.forename: T
authors.initials: T
authors.lastname: Segura
authors.forename: C
authors.initials: C
authors.lastname: Jiménez
authors.forename: J
authors.initials: J
authors.lastname: Masjuán
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*