Recurrent stroke risk steady after TIA, minor stroke

The risk for CV events was consistent over 5 years in patients who had transient ischemic attack or minor stroke, according to a study presented at the European Stroke Organization Conference and published in The New England Journal of Medicine.

“There may be potential for reducing recurrent strokes by ongoing secondary prevention measures,” Pierre Amarenco, MD, of the department of neurology and stroke center at Bichat Hospital in Paris, and colleagues wrote.

Researchers analyzed data from 3,847 patients (mean age, 66 years; 60% men) who had a TIA or minor stroke within 7 days. Stroke specialists assessed the patients for brain or focal retinal ischemia and a modified Rankin score of 0 or 1. Other evaluations were performed to collect information on medical history, socioeconomic factors and clinical symptoms. Researchers also performed cardiac evaluations and cerebral-artery and brain imaging.

Stroke specialists at the different centers decided on the medical treatment and endovascular revascularization procedures that patients underwent.

Face-to-face interviews were conducted to collect patient information at baseline, 1 month, 3 months, 12 months and every 12 months thereafter for 5 years. Follow-up also included evaluations for medical treatment, clinical events and CV risk factors.

The primary outcome was a composite of first instance of nonfatal stroke, CV-related death or nonfatal ACS. Secondary outcomes included TIA recurrence, any bleeding in the brain or in another location in the body, all-cause death, individual components of the primary outcome and modified Rankin score at last follow-up.

At 5 years, the primary outcome was seen in 469 patients, which corresponded with an estimated cumulative event rate of 12.9% (95% CI, 11.8-14.1). Fifty percent of these events occurred between the second and fifth years.

During follow-up, 345 patients had strokes with an estimated cumulative rate of 9.5% (95% CI, 8.5-10.5). Of these patients, 43.2% had a stroke during the second through fifth years.

The rate of all-cause death at 5 years was 10.6%, 2.7% of patients died from CV causes, death from intracranial hemorrhage occurred in 1.1% of patients, and 1.5% died from major bleeding.

Independent predictors of recurrent stroke during the second through fifth years of the study were cardioembolism, ipsilateral large-artery atherosclerosis and an ABCD² score of 4 or higher.

“Taken together, and given the specialized nature of the sites in the registry, these patients are different from those in population-based studies of stroke but may represent patients who would be included in clinical trials,” Amarenco and colleagues wrote. – by Darlene Dobkowski

References:

Amarenco P, et al. Presidential Symposium - Awards & Trials. Presented at: European Stroke Organization Conference; May 16-18, 2018; Gothenburg, Sweden.

Amarenco P, et al. N Engl J Med. 2018;doi:10.1056/NEJMoa1802712.

Disclosures: The study was funded by AstraZeneca, Bristol-Myers Squibb and Sanofi. Amarenco reports he received both grants and personal fees from AstraZeneca, Bristol-Myers Squibb, Pfizer, Sanofi, and personal fees from Bayer, Boehringer-Ingelheim, Boston Scientific, Daiichi Sankyo, Fibrogen, GlaxoSmithKline, Kowa Company, Medtronic and Shing Poon. Please see the study for all other authors’ relevant financial disclosures.