Physicians have long been interested in the long-term determinants of survival and of risk of vascular events after minor ischemic stroke or TIA. In a prospective cohort of 2,473 participants from the Dutch TIA Trial (recruitment from 1986 to 1989), van Wijk and colleagues re-evaluated the ten-year risk of vascular events after TIA or minor ischemic stroke. After a mean follow-up of 10.1 years, 1,489 (60%) patients had died and 1,336 (54%) had had at least one additional vascular event. The ten-year risk of death and vascular event was 42.7% (95% CI, 40.8%-44.7%) and 44.1% (42.0%-46.1%), respectively. The risk for any vascular event including stroke was highest immediately after the ischemic event, but then began a decline that reached its lowest point about three years after the stroke. In the Dutch TIA study, predictors of death and the occurrence of a vascular event included age, diabetes, and evidence of vascular disease (van Wijk, 2005).
A recent meta-analysis to evaluate the risk of MI and vascular death after TIA and ischemic stroke included 39 studies and a total of 65,996 patients with mean follow-up of 3.5 years (Touzé, 2005). The annual risks were 2.1% (CI 95%, 1.9%-2.4%) for nonstroke vascular death, 2.2% (1.7%-2.7%) for total MI, 0.9% (0.7%-1.2%) for nonfatal MI, and 1.1% (0.8%-1.5%) for fatal MI. The time course of the risk of each outcome was also linear.
Because risks can change over time, patients with TIA and minor ischemic stroke should continue to be reassessed and treated to prevent cerebrovascular and cardiovascular events for the long term.
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