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. 2021 Mar;6(1):53-61.
doi: 10.1177/2396987320975980. Epub 2020 Dec 13.

Age in relation to comorbidity and outcome in patients with high-risk TIA or minor ischemic stroke: A Swedish national observational study

Oskar Fasth  1 , Eva Lesén  2 , Peter Appelros  3 , Bahman Farahmand  4 , Jonatan Hedberg  2 , Per Ladenvall  2 , Carl Mellström  2 , Signild Åsberg  1
Affiliations

Age in relation to comorbidity and outcome in patients with high-risk TIA or minor ischemic stroke: A Swedish national observational study

Oskar Fasth et al. Eur Stroke J. 2021 Mar.

Abstract

Introduction: Recent trials report positive results for preventing vascular events with dual antiplatelet therapy (DAPT) in patients with high-risk TIA or minor ischemic stroke. We aimed to investigate this population regarding influence of age on vascular risk factors, hospital stay and mortality.

Patients and methods: Data on patients aged 40-100 years with TIA or ischemic stroke in the Swedish Stroke Register during 2012-13 were linked with national registers. To identify patients with high-risk TIA (ABCD2 ≥6) or minor ischemic stroke (NIHSS ≤5) eligible for DAPT, we excluded patients with atrial fibrillation, anticoagulant use, prior major bleeding, or unknown stroke severity.

Findings: We identified 10,053 potential DAPT-candidates (mean age 72.6 years, 45.2% female, 16.4% with TIA). With advancing age, most vascular risk factors increased. Antiplatelet treatment increased from 31.9% before the event to 95.5% after discharge. Within 1 year following index event, the proportion of patients with ≥1 re-admission increased with age (29.2% in 40-64 year-olds; 47.2% in 85-100 year-olds). All-cause death per 100 person-years was 6.9 (95% CI 6.4-7.4) within 1 year, and highest in the first 30 days (15.2; 95% CI 12.8-18.2). For each year of increased age, the risk of death increased with 3.5% (p = 0.128) in patients 40-64 years and with 11.8% (p < 0.001) in those ≥85 years.

Conclusions: While in theory representing a subset of patients with mild injury, our observational study highlights substantial use of health-care resources and high mortality rates among patients with high-risk TIA or minor ischemic stroke assumed eligible for DAPT.

Keywords: Ischemic attack; epidemiology; ischemic stroke; mortality; mortality/survival; platelet aggregation inhibitors; registries; secondary prevention; stroke; transient; transient ischemic attack (TIA).

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BF, OF, and PA declare no conflicts of interest in relation to this study; JH, PL, EL, and CM are employees of AstraZeneca; SÅ has received institutional research funding from AstraZeneca.

Figures

Figure 1.
Figure 1.
Cumulative incidence of all-cause mortality in 10,053 patients with high-risk TIA or minor ischemic stroke, by age. Numbers below graph denote patients alive at each time point.
See this image and copyright information in PMC

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