University of Pennsylvania School of Medicine, Department of Neurology, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Stroke. 2011 Dec;42(12):3612-3. doi: 10.1161/STROKEAHA.111.627877. Epub 2011 Sep 15.
The recent redefinition of transient ischemic attack (TIA) reclassifies patients with acute infarction on magnetic resonance imaging as ischemic stroke. Redefinition will improve the prognosis of both TIA and ischemic stroke, an epidemiological paradox known as the Will Rogers phenomenon. We sought to quantify the impact of this phenomenon.
Incidence of TIA, risk of death/disability after stroke, rate of acute infarction on magnetic resonance imaging after TIA, and 90-day stroke risk after TIA with and without infarction on magnetic resonance imaging were determined based on published data. The impact on poststroke disability in the redefined cohort of patients with ischemic stroke was computed. A sensitivity analysis was performed to account for uncertainty in input variables.
Using the new TIA definition, the 90-day risk of stroke following TIA is 1%. In the United States, redefinition will increase annual ischemic stroke incidence from 691,650 to 747,755 and result in a 3.4% absolute reduction in poststroke disability. In a sensitivity analysis, this risk reduction varies from 1.5 to 6.5%, and is most dependent on the incidence of TIA.
Redefinition of TIA reduces stroke risk after TIA to approximately 1% at 90 days, and reduces the rate of poststroke disability by approximately 3.4%.
短暂性脑缺血发作（TIA）的最新定义将磁共振成像上的急性梗死患者重新归类为缺血性卒中。这种重新定义将改善 TIA 和缺血性卒中的预后，这是一种被称为威尔·罗杰斯现象的流行病学悖论。我们试图量化这种现象的影响。
根据已发表的数据，确定 TIA 的发病率、卒中后死亡/残疾风险、TIA 后磁共振成像上急性梗死的发生率以及 TIA 后有无磁共振成像上梗死的 90 天卒中风险。计算重新定义的缺血性卒中患者队列中卒中后残疾的影响。进行敏感性分析以考虑输入变量的不确定性。
使用新的 TIA 定义，TIA 后 90 天内卒中风险为 1%。在美国，重新定义将使每年缺血性卒中的发病率从 691,650 例增加到 747,755 例，并导致卒中后残疾的绝对减少 3.4%。在敏感性分析中，这种风险降低幅度从 1.5%到 6.5%不等，且最依赖于 TIA 的发病率。
TIA 的重新定义将 TIA 后 90 天的卒中风险降低到约 1%，并将卒中后残疾率降低约 3.4%。
