Relative Survival After Transient Ischaemic Attack: Results From the Program of Research Informing Stroke Management (PRISM) Study

• Published in: Stroke (1970) Vol. 43; no. 1; pp. 79 - 85
• Main Authors: GATTELLARI, Melina, GOUMAS, Chris, GARDEN, Frances, BIOST, M, WORTHINGTON, John M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2012
• Subjects: Aged; Aged, 80 and over; Australia - epidemiology; Biological and medical sciences; Female; Follow-Up Studies; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospitalization; Humans; Ischemic Attack, Transient - mortality; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Prognosis; Risk Factors; Sex Factors; Stroke - mortality; Survival Rate; Vascular diseases and vascular malformations of the nervous system; Australia; relative survival; Stroke; Nervous system diseases; Cardiovascular disease; Survival; Cerebral disorder; Vascular disease; follow-up; transient ischaemic attack; Clinical management; Ischemia; Central nervous system disease; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.111.636233

There is a lack of modern-day data quantifying the effect of transient ischemic attack (TIA) on survival, and recent data do not take into account expected survival.
Data for 22 157 adults hospitalized with a TIA from July 1, 2000, to June 30, 2007, in New South Wales, Australia, were linked with registered deaths to June 30, 2009. We estimated survival relative to the age- and sex-matched general population up to 9-years after hospitalization for TIA comparing relative risk of excess death between selected subgroups.
At 1 year, 91.5% of hospitalized patients with TIA survived compared with 95.0% expected survival in the general population. After 5 years, observed survival was 13.2% lower than expected in relative terms. By 9 years, observed survival was 20% lower than expected. Females had higher relative survival than males (relative risk, 0.79; 95% CI, 0.69-0.90; P<0.001). Increasing age was associated with an increasing risk of excess death compared with the age-matched population. Prior hospitalization for stroke (relative risk, 2.63; 95% CI, 1.98-3.49) but not TIA (relative risk, 1.42; 95% CI, 0.86-2.35) significantly increased the risk of excess death. Of all risk factors assessed, congestive heart failure, atrial fibrillation, and prior hospitalization for stroke most strongly impacted survival.
This study is the first to quantify the long-term effect of hospitalized TIA on relative survival according to age, sex, and medical history. TIA reduces survival by 4% in the first year and by 20% within 9 years. TIA has a minimal effect on mortality in patients <50 years but heralds significant reduction in life expectancy in those >65 years.