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Online Clinical Calculator |
Annual rate of adverse nonstroke
events after TIA/stroke about 2%
|
Clinical Question:
What is the likelihood of serious nonstroke health outcomes following
transient ischemic attacks or strokes?
Bottom Line:
Patients with TIA or stroke have a relatively high risk of MI and nonstroke
vascular death. Additional research is needed to identify the determinants
of coronary artery disease in stroke patients.Following a stroke or
transient ischemic attack (TIA), the annual rate of nonstroke vascular death
and myocardial infarction (MI) is approximately 2% per year. This
information can be used to inform patients about the clinical course of
their disease.
Reference:
Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of
myocardial infarction and vascular death after transient ischemic attack and
ischemic stroke: a systematic review and meta-analysis. Stroke
2005;36:2748-55.
Study Design:
Meta-analysis (other)
Synopsis:
Whether stroke patients should be investigated for asymptomatic coronary
artery disease remains matter of debate. Absolute risks of myocardial
infarction (MI) and vascular death after a stroke have not been accurately
assessed. We performed a systematic review and a meta-analysis to determine
the risk of MI and nonstroke vascular death after transient ischemic attack
(TIA) and ischemic stroke. Cohort studies of TIA or ischemic stroke patients
were included if they were published between 1980 and March 2005, reported
risk of MI and nonstroke vascular death, enrolled >100 patients, and had at
least 1 year of follow-up. We included 39 studies in a total of 65,996
patients with mean follow-up of 3.5 years. Two reviewers independently
carried out data extraction using a standardized form. Absolute annual risks
were estimated through weighted meta-regressions with a random effect. To
test the predictions of expected event rates derived from our analysis, we
used individual patient data. The annual risks were 2.1% (CI 95%: 1.9 to
2.4) for nonstroke vascular death, 2.2% (1.7 to 2.7) for total MI, 0.9% (0.7
to 1.2) for nonfatal MI and 1.1% (0.8 to 1.5) for fatal MI. The time course
of risk was linear. Estimated risks fitted well with observed risks at the
individual level. There was no heterogeneity in the absolute risks according
to baseline study characteristics. |
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