A prognostic system for transient ischemia or minor stroke

• Published in: Annals of internal medicine Vol. 114; no. 7; p. 552
• Main Authors: Kernan, W N, Horwitz, R I, Brass, L M, Viscoli, C M, Taylor, K J
• Format: Journal Article
• Language: English
• Published: United States 01-04-1991
• Subjects: Aged; Carotid Arteries - diagnostic imaging; Cerebrovascular Disorders - diagnostic imaging; Cerebrovascular Disorders - mortality; Cerebrovascular Disorders - physiopathology; Cohort Studies; Female; Humans; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - physiopathology; Male; Middle Aged; Prognosis; Recurrence; Risk Factors; Statistics as Topic; Ultrasonography
• ISSN: 0003-4819
• DOI: 10.7326/0003-4819-114-7-552

To build a prognostic system for patients with carotid transient ischemic attack or minor stroke.
Inception cohort study with 2-year follow-up.
Urban community teaching hospital.
Eligible patients (n = 142), identified on a carotid ultrasound roster, had been hospitalized between 1984 and 1987 within 30 days of a first carotid transient ischemic attack or minor stroke.
Stroke or death within 2 years.
Three factors were associated with stroke or death: age of more than 65 years, diabetes, and hypertension. Based on regression coefficients, age of more than 65 years was assigned 3 points; diabetes, 3 points; and hypertension, 2 points. An initial prognostic system comprised risk groups 1 (0 points), 2 (1 to 5 points), and 3 (6 to 8 points). Outcome rates in the three groups were 2%, 31%, and 54% (P less than 0.0001), respectively. In an independent test sample, the corresponding outcome rates for the initial system were 12%, 21%, and 31% (P = 0.04). A final prognostic system, including two additional predictors (coronary heart disease [1 point] and the distinction between stroke and transient ischemic attack for the baseline event [2 points]), comprised risk groups 1 (0 to 2 points), 2 (3 to 6 points), and 3 (7 to 11 points). Corresponding outcome rates were 3%, 27%, and 48% (P less than 0.001) in the original cohort and 10%, 21%, and 59% (P less than 0.001) in the test cohort.
For selected patients with carotid transient ischemia or minor stroke, five clinical features can be combined to stratify effectively the risk for a subsequent stroke or death.