Dept of cardiovascular medicine, National Cerebral and Cardiovascular Cntr, Osaka, Japan
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Background and purpose: Patients with transient ischemic attack (TIA) occasionally accompany nonfocal symptoms, such as decreased consciousness, confusion, amnesia, and unsteadiness. The purpose of this study was to clarify characteristics and prognosis of TIA patients having nonfocal symptoms, using data of the PROspective Multicenter registry to Identify Subsequent cardiovascular Events after TIA (PROMISE-TIA).Methods: Patients with TIA within 7 days of onset were consecutively enrolled in the Japanese nationwide registry. Factors associated with nonfocal symptoms and 1-year risk of ischemic stroke and ischemic heart disease were assessed in logistic regression and Kaplan-Meier models, respectively.Results: We studied 1348 patients with TIA (871 men, mean age of 69.4±12.4 years). Two hundred and nineteen patients (16%) had nonfocal symptoms. Patients with nonfocal symptoms were more likely to have both diffusion-weighted imaging (DWI)-positive lesions and stenosis/occlusion on vascular examination (magnetic resonance/computed tomographic angiography, or carotid ultrasound) in posterior circulation than those without (11% vs. 4%, p<0.001, 20% vs. 11%, p<0.001), but were otherwise broadly similar with respect to other baseline characteristics. Although 1-year risk of ischemic stroke was not different between the two groups (7.5% vs. 8.2%, p=0.756), the risk of ischemic heart disease was higher in patients with nonfocal symptoms (3.1% vs. 1.2%, p=0.046).Conclusions: Both ischemic changes and arterial stenosis/occlusion in posterior circulation were more frequently observed in TIA patients with nonfocal symptoms and they seem to be at high risk of ischemic heart disease.Clinical Trial Registration: URL: http://www.clinicaltraial.gov. Unique identifier: NCT01581502.