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. 2024 May 27:15:1407598.
doi: 10.3389/fneur.2024.1407598. eCollection 2024.

Enhancing stroke risk prediction in patients with transient ischemic attack: insights from a prospective cohort study implementing fast-track care

Valentina Barone #  1 , Matteo Foschi #  2   3 , Lucia Pavolucci  3 , Francesca Rondelli  1 , Rita Rinaldi  1 , Marianna Nicodemo  1 , Roberto D'Angelo  1 , Elisabetta Favaretto  4 , Carlotta Brusi  4 , Benilde Cosmi  4 , Daniela Degli Esposti  5 , Sergio D'Addato  5   6 , Stefano Bacchelli  5 , Fabrizio Giostra  7 , Daniela Paola Pomata  7 , Luca Spinardi  8 , Luca Faccioli  8 , Gianluca Faggioli  9 , Andrea Donti  10 , Claudio Borghi  5 , Pietro Cortelli  1   11 , Maria Guarino  1 ; Bologna TIA Study Group
Affiliations

Enhancing stroke risk prediction in patients with transient ischemic attack: insights from a prospective cohort study implementing fast-track care

Valentina Barone et al. Front Neurol. .

Abstract

Background and aims: Fast-track care have been proved to reduce the short-term risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short- and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management.

Methods: Prospective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017. All patients underwent fast-track care within 24 h of admission. The primary outcome was defined as the first stroke recurrence at 90 days, 12 and 60 months after TIA. Stroke incidence with 95% confidence interval (CI) at each timepoint was calculated using Poisson regression. Predictors of stroke recurrence were evaluated with Cox regression analysis. The number needed to treat (NNT) of fast-track care in preventing 90-day stroke recurrence in respect to the estimates based on baseline ABCD2 score was also calculated.

Results: We enrolled 1,035 patients (54.2% males). Stroke incidence was low throughout the follow-up with rates of 2.2% [95% CI 1.4-3.3%] at 90 days, 2.9% [95% CI 1.9-4.2%] at 12 months and 7.1% [95% CI 5.4-9.0%] at 60 months. Multiple TIA, speech disturbances and presence of ischemic lesion at neuroimaging predicted stroke recurrence at each timepoint. Male sex and increasing age predicted 90-day and 60-month stroke risk, respectively. Hypertension was associated with higher 12-month and 60-month stroke risk. No specific TIA etiology predicted higher stroke risk throughout the follow-up. The NNT for fast-track care in preventing 90-day stroke was 14.5 [95% CI 11.3-20.4] in the overall cohort and 6.8 [95% CI 4.6-13.5] in patients with baseline ABCD2 of 6 to 7.

Conclusion: Our findings support the effectiveness of fast-track care in preventing both short- and long-term stroke recurrence after TIA. Particular effort should be made to identify and monitor patients with baseline predictors of higher stroke risk, which may vary according to follow-up duration.

Keywords: fast-track; number needed to treat; outcomes; predictors; stroke; transient ischemic attack.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Study flow diagram. CT, computed tomography; ECG, electrocardiography; TIA, transient ischemic attack.
Figure 2
Figure 2
Kaplan–Meier hazard function of stroke risk after transient ischemic attack (TIA) during the overall follow-up. The upper and lower bounds of the gray area surrounding the hazard curve indicate upper and lower 95% confidence interval.
See this image and copyright information in PMC

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