TIA and minor stroke associated with disability at 90 days

A detailed prospective study of transient ischemic attacks (TIAs) and minor stroke found 15% of patients were disabled at 90 days, even though most of them did not have a recurrent event.

Researchers prospectively enrolled consecutive patients with stroke rated less than 4 on the National Institutes of Health Stroke Scale or patients with TIA who were previously not disabled and had computed tomography or computed tomography angiography (CT/CTA) within 24 hours of symptoms.

Disability was assessed at 90 days using the modified Rankin Scale. Predictors of disability (modified Rankin Scale ≥2) and the relative impact of the initial event versus recurrent events were assessed. Results were published online Sept. 13 by Stroke.

Among 499 patients, 74 (15%; 95% CI, 12% to 18%) were disabled at 90 days. Baseline factors predicting disability as an outcome included being 60 years or older, having diabetes, having a premorbid modified Rankin Scale 1, having ongoing symptoms, having a CT/CTA-positive metric, or having positive diffusion-weighted imaging.

In the multivariable analysis, factors that predicted disability included ongoing symptoms (odds ratio [OR], 2.4; 95% CI, 1.3 to 4.4; P=0.004), diabetes (OR, 2.3; 95% CI, 1.2 to 4.3; P=0.009), female sex (OR, 1.8; 95% CI, 1.1 to 3; P=0.025), and CT/CTA-positive metric (OR, 2.4; 95% CI, 1.4 to 4; P=0.001).

Of the 463 patients who did not have a recurrent event, 55 were disabled (12%). Of the 36 who did have a recurrent event, 19 (53%) patients were disabled (risk ratio, 4.4; 95% CI, 3 to 6.6; P<0.0001). Researchers noted that recurrent events are a very important surrogate for disability but are numerically not the major factor in predicting disability.

“There has been a general emphasis on recurrent events after minor stroke or TIA rather than on disability, yet disability is the accepted outcome after disabling stroke,” researchers wrote. “Our study is novel in that it emphasizes the need to examine disability even in minor stroke and brings together … careful clinical assessments and imaging data to emphasize this point.”