Background: Risk of acute ischemic stroke (AIS) or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. We aimed to find out early vascular events (EVEs) and late vascular events (LVEs) [AIS, hemorrhagic stroke (HS), myocardial infarction (MI), angina, and atrial fibrillation (AFib)], outcomes, and predictors of fatality in TIA hospitalization.
Methods: We performed a retrospective analysis of Nationwide Inpatient Sample (years 2007-2014) in adult hospitalizations for TIA to find out EVEs and with past medical history (PMH) of TIA to find out LVEs using ICD-9-CM codes. We performed analyses using Chi-square to compare the outcomes (Death, Risk of Death, Loss of Function, and poor Discharge Disposition) amongst EVEs and LVEs. Multivariate survey logistic regression was done to evaluate the outcomes and predictors of fatality.
Results: From years 2007 to 2014, total 11,776,757 (TIA: 1,948,818; PMH TIA: 9,827,939) patients with TIA were hospitalized. LVEs were more common in TIA patients except for HS. LVEs were associated with the significantly higher mortality (2.8% vs 0.6%; aOR: 4.22; 95% CI: 3.97-4.48) and poor overall outcomes in compare to EVEs (Table). Independent predictors of fatality were AIS (aOR: 3.03; 95% CI: 2.75-3.34), HS (aOR: 3.74; 95%CI: 3.25-4.31), MI (aOR: 3.52; 95% CI: 3.30-3.75), and AFib (aOR: 1.32; 95% CI: 1.28-1.37). Other predictors with higher odds of fatality were age >65, Asian and Pacific Islander, male, weekend admissions, peripheral vascular disease, CHF, renal failure, coagulopathies, and alcohol abuse (Table).
Conclusion: Following TIA, patients could be at risk of many vascular events and not an only stroke. We observed poor outcomes amongst patients of TIA with LVEs. Identification of such patients, long term risk stratification, and secondary prevention through regular follow-up play a very crucial role to identify patients at risk to prevent LVEs following TIA.