From the Department of Cardiology (K.A.C., A.A., N.E.V., J.H.B., M.N.K., L.K., E.F.), Rigshospitalet, Copenhagen University Hospital; Danish Center for Health Services Research (S.P.J.), Department of Clinical Medicine, Aalborg University; Department of Brain and Spinal Cord Injury (C.K.), Neuroscience Center, Rigshospitalet, Copenhagen University Hospital; Department of Cardiology (M.S.), Copenhagen University Hospital, Herlev and Gentofte; and Department of Cardiology and Clinical Investigation (C.T.-P.), Nordsjællands Hospital, Hillerød, Denmark.
Neurology. 2024 Dec 24;103(12):e210053. doi: 10.1212/WNL.0000000000210053. Epub 2024 Nov 25.
Transient ischemic attack (TIA) is associated with a higher short-term incidence of stroke. However, long-term data on this association are lacking. Therefore, this study aimed to determine the long-term incidence of ischemic stroke after TIA according to ABCD score and to identify factors associated with stroke after TIA.
All Danish patients ≥18 years with first-time TIA were included from the Danish Stroke Registry (2014-2020). The study population was stratified into a high-risk (≥4 points) and low-risk (<4 points) group according to the modified ABCD score (age ≥60 years, hypertension, clinical features, and diabetes). The 3-year cumulative incidence of stroke and all-cause mortality was assessed using the Aalen-Johansen and Kaplan-Meier estimators, respectively. Factors associated with 3-year stroke rate were identified using multivariable Cox regression models.
In total, 21,433 patients with first-time TIA were included: 1,280 (6.0%) in the high-risk group and 20,153 (94.0%) in the low-risk group. Patients with high-risk ABCD scores were older (median 77.5 [P25-P75 70.8-84.1] vs 70.3 [P25-P75 60.1-78.2]), more often female (53.1%), had more comorbidities (e.g., ischemic heart disease, heart failure, and atrial fibrillation), and received more medication (e.g., any antiplatelet therapy or oral anticoagulants and cholesterol-lowering drugs) at baseline. The 3-year cumulative incidence of stroke after TIA was 6.0% (95% CI 4.6-7.5) in the high-risk group and 4.2% (95% CI 3.9-4.5) in the low-risk group ( = 0.004) with an unadjusted hazard ratio (HR) 1.56 (95% CI 1.21-2.00). Factors associated with 3-year stroke rate included age ≥60 years (HR 2.21, 95% CI 1.76-2.78), current smoking (HR 1.37, 95% CI 1.13-1.65), unilateral weakness (HR 1.25, 95% CI 1.04-1.51), peripheral artery disease (HR 1.53, 95% CI 1.09-2.14), and chronic kidney disease (HR 1.39, 95% CI 1.01-1.90). The 3-year cumulative incidence of all-cause mortality was 28.9% (95% CI 26.1-31.7) in the high-risk group and 10.3% (95% CI 9.9-10.8) in the low-risk group.
Patients with high-risk ABCD score had an almost 60% higher associated long-term rate of ischemic stroke compared with those with low-risk ABCD score. Future trials focusing on preventive strategies, including evidence-based antithrombotic strategies, especially for the high-risk group are warranted.
短暂性脑缺血发作（TIA）与短期中风发生率较高相关。然而，关于这种关联的长期数据尚缺乏。因此，本研究旨在根据 ABCD 评分确定 TIA 后缺血性中风的长期发生率，并确定与 TIA 后中风相关的因素。
纳入来自丹麦中风登记处（2014-2020 年）的所有年龄≥18 岁且首次发生 TIA 的丹麦患者。根据改良的 ABCD 评分（年龄≥60 岁、高血压、临床特征和糖尿病），将研究人群分为高危（≥4 分）和低危（<4 分）组。使用 Aalen-Johansen 和 Kaplan-Meier 估计器分别评估 3 年累积中风发生率和全因死亡率。使用多变量 Cox 回归模型确定与 3 年中风发生率相关的因素。
共纳入 21433 例首次发生 TIA 的患者：高危组 1280 例（6.0%），低危组 20153 例（94.0%）。高危 ABCD 评分患者年龄较大（中位数 77.5 [P25-P75：70.8-84.1] vs 70.3 [P25-P75：60.1-78.2]），女性更多（53.1%），合并症更多（如缺血性心脏病、心力衰竭和心房颤动），基线时接受更多药物治疗（如任何抗血小板治疗或口服抗凝剂和降胆固醇药物）。高危组 TIA 后 3 年中风发生率为 6.0%（95%CI：4.6-7.5），低危组为 4.2%（95%CI：3.9-4.5）（=0.004），未调整的危险比（HR）为 1.56（95%CI：1.21-2.00）。与 3 年中风率相关的因素包括年龄≥60 岁（HR 2.21，95%CI：1.76-2.78）、当前吸烟（HR 1.37，95%CI：1.13-1.65）、单侧无力（HR 1.25，95%CI：1.04-1.51）、外周动脉疾病（HR 1.53，95%CI：1.09-2.14）和慢性肾病（HR 1.39，95%CI：1.01-1.90）。高危组 3 年全因死亡率为 28.9%（95%CI：26.1-31.7），低危组为 10.3%（95%CI：9.9-10.8）。
与低危 ABCD 评分患者相比，高危 ABCD 评分患者的长期中风发生率高近 60%。需要进一步的试验，重点关注预防策略，包括基于证据的抗血栓策略，特别是高危患者。
