Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

Ois, Ángel; Gomis, Meritxell; Rodríguez-Campello, Ana; Cuadrado-Godia, Elisa; Jiménez‐Conde, Jordi; Pont‐Sunyer, Claustre; Cuccurella, Gracia; Roquer, Jaume

doi:10.1161/strokeaha.107.505438

Cited by 147 publications

(123 citation statements)

References 35 publications

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“…Recurrence of IS was defined as a new focal neurological deficit of vascular origin lasting >24 hours and without hemorrhage on computed tomography or MRI of the brain. 12 At 3, 6, and 12 months after discharge, patients or their relatives were contacted over the telephone by trained research personnel at Beijing Tian Tan hospital and were asked whether patients had new symptoms or hospitalized again with another stroke. All recurrence or progressive deterioration of IS was verified at the index hospitals based on the NIHSS score and the presence of new neurological deficits documented in the medical records in combination with computed tomography or MRI images.…”

Section: Follow-up and Clinical Outcome Evaluationsmentioning

confidence: 99%

Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction

Zhang

Wang

et al. 2014

Stroke

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Chinese Intracranial Atherosclerosis (CICAS) is a prospective, multicenter, hospital-based study. Clinical and imaging data were prospectively collected from consecutive patients with IS or transient Background and Purpose-Single subcortical infarction (SSI) may be classified as proximal SSI (pSSI) or distal SSI (dSSI) according to its location within the middle cerebral artery territory. Few studies have examined the differences in clinical outcome between the two. Our study investigated such differences in patients with pSSI or dSSI and examined their baseline characteristics and indicators for small-vessel disease. Methods-We prospectively enrolled 400 patients with SSI (208 pSSI and 192 dSSI) who had no middle cerebral artery disease on MR angiography. Data compared included clinical information, lesion size, prevalence of lacune and leukoaraiosis at baseline, National Institutes of Health Stroke Scale score and modified Rankin Scale score at discharge, and any deterioration during admission or recurrence of ischemic stroke <1 year. Results-In multivariable logistic regression analysis, dSSI was independently associated with patient's history of stroke, admission National Institutes of Health Stroke Scale score ≤3, Fazekas score ≥3, presence of lacune, but not hyperlipidemia. Patients with dSSI had shorter length of hospital stay, lower rate of functional dependence at discharge (modified Rankin Scale score ≥2), and lower deterioration or recurrence risk of ischemic stroke in 1 year. Multivariable logistic regression analysis showed that factors associated with higher deterioration or recurrence risk of ischemic stroke at 1 year included female sex, history of coronary heart disease, pSSI, and not on antithrombotics <48 hours of admission. Conclusions-Compared with pSSI, patients with dSSI likely had small-vessel diseases but better clinical outcome.

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Section: Follow-up and Clinical Outcome Evaluationsmentioning

confidence: 99%

Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction

Zhang

Wang

et al. 2014

Stroke

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“…However, TIA patients are a heterogeneous group in terms of symptoms, risk factors, underlying pathology, and early prognosis. 3 The presence of large-artery atherosclerosis (LAA) has been the main established predictor of subsequent stroke [4][5][6] so far, but a definitive prognostic tool for stroke recurrence (SR) is not defined.…”

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confidence: 99%

“…[4][5][6] We evaluated metabolomic profiles of patients with symptomatic carotid or intracranial stenosis of at least 50%. The results (figure 1E) revealed that metabolomic profiles are able to offer a high accuracy predicting presence of LAA (PLS-DA accuracy 91%-98%, positive: specificity 5 0.79, sensitivity 5 1; negative: specificity 5 0.86, sensitivity 5 1; dataset 1).…”

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confidence: 99%

Metabolomics predicts stroke recurrence after transient ischemic attack

et al. 2015

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Objective: To discover, by using metabolomics, novel candidate biomarkers for stroke recurrence (SR) with a higher prediction power than present ones.Methods: Metabolomic analysis was performed by liquid chromatography coupled to mass spectrometry in plasma samples from an initial cohort of 131 TIA patients recruited ,24 hours after the onset of symptoms. Pattern analysis and metabolomic profiling, performed by multivariate statistics, disclosed specific SR and large-artery atherosclerosis (LAA) biomarkers. The use of these methods in an independent cohort (162 subjects) confirmed the results obtained in the first cohort.Results: Metabolomics analyses could predict SR using pattern recognition methods. Low concentrations of a specific lysophosphatidylcholine (LysoPC[16:0]) were significantly associated with SR. Moreover, LysoPC(20:4) also arose as a potential SR biomarker, increasing the prediction power of age, blood pressure, clinical features, duration of symptoms, and diabetes scale (ABCD2) and LAA. Individuals who present early (,3 months) recurrence have a specific metabolomic pattern, differing from non-SR and late SR subjects. Finally, a potential LAA biomarker, LysoPC(22:6), was also described. Conclusions:The use of metabolomics in SR biomarker research improves the predictive power of conventional predictors such as ABCD2 and LAA. Moreover, pattern recognition methods allow us to discriminate not only SR patients but also early and late SR cases. Neurology ® 2015;84:36-45 GLOSSARY ABCD2 5 age, blood pressure, clinical features, duration of symptoms, and diabetes scale; IDI 5 integrated discrimination improvement; LAA 5 large-artery atherosclerosis; Lp-PLA 5 lipoprotein-associated phospholipase A; NRI 5 net reclassification improvement; LysoPC 5 lysophosphatidylcholine; MS/MS 5 tandem mass spectrometry; PLS-DA 5 partial least squares discriminant analysis; ROC 5 receiver operating characteristic; SLC 5 solute carrier; SR 5 stroke recurrence.

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“…Factors associated with a high risk of recurrence in patients with TIA or minor stroke were different from those of general stroke16; however, data from previous studies were derived from trials or cohorts in which patients were recruited weeks or months after their initial event and underestimated early recurrence, especially for minor stroke or TIA 8, 9, 17. Consequently, the risks of recurrent stroke caused by METS and DM in patients with a minor stroke or TIA should be further examined.…”

Section: Introductionmentioning

confidence: 99%

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

Chen

Pan

Jing

et al. 2017

JAHA

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BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

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Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

Cited by 147 publications

References 35 publications

Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction

Distal Single Subcortical Infarction Had a Better Clinical Outcome Compared With Proximal Single Subcortical Infarction

Metabolomics predicts stroke recurrence after transient ischemic attack

Recurrent Stroke in Minor Ischemic Stroke or Transient Ischemic Attack With Metabolic Syndrome and/or Diabetes Mellitus

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