Abstract TMP118: Outcomes of Previously Identified Transient Ischemic Attack Among Acute Ischemic Stroke Hospitalization and Predictors of Fatal Stroke

Abstract

Background: Patients with transient ischemic attack (TIA) or minor stroke are at increased risk of recurrent stroke, and therefore require urgent evaluation and treatment since immediate intervention may substantially reduce the risk of recurrent stroke and improve the outcome. We hypothesized that AIS hospitalizations with previously identified/personal medical history (PMH) of TIA are associate with lower all cause in-patient mortality, likelihood of death and disability. Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (NIS) (years 2007-2013) in adult hospitalizations for AIS to compare the outcomes [Death, APRDRG Risk Mortality (likelihood of dying), and APRDRG Severity (loss of function)] amongst TIA patients using ICD-9-CM codes. We performed weighted analyses using Chi-square and Jonckheere-Terpstra trend test. Multivariate survey logistic regression was done to evaluate the association of PHO TIA with poor outcomes and predictors of fatal stroke in PHO TIA patients. Results: Between years 2007 to 2013, total 3,082,973 patients with stroke were hospitalized. Of these admissions, 315,026(10.22%) patients also had PMH of TIA as a concurrent diagnosis. There was a substantial increase in rates of PMH TIA among stroke patients; 1.28% in 2007 to 13.34% in 2013 (p<0.0001). On multivariate regression analysis, there was a statistically significant lower mortality (OR:0.8; 95%CI:0.75-0.85), Risk Mortality (OR:0.85; 95%CI:0.82-0.88), and Risk Severity (OR:0.87; 95%CI:0.84-0.89) in stroke patients with PMH TIA compared to those without PMH TIA or unidentified TIA. Independent predictors of fatal stroke in PMH of TIA patients included age >80 (aOR:3.98; 95%CI:1.15-13.76), comorbid congestive heart failure (aOR:1.79; 95%CI:1.53-2.09), coagulopathies (aOR:1.47; 95%CI:1.06-2.04), hemorrhage transformation (aOR:4.65; 95%CI:3.49-6.19), and atrial fibrillation (aOR:1.77; 95%CI:1.54-2.03). Conclusion: We observed better outcomes amongst pre-identified TIA patients during stroke hospitalization than previously non-reported. That’s why risk stratification and secondary prevention play a very crucial role to improve outcomes of stroke by identifying and managing TIA.