How is your competent? doctor GUARANTEEING NO STROKE after your current one?
Risk of Recurrent Stroke After TIA or Minor Stroke Is High, 10% of Which May Be Fatal
Within 10 years of experiencing a transient ischaemic attack (TIA) or minor stroke, approximately 1 in 5 patients were at risk of having another stroke and 10% of all subsequent stroke events were likely to be fatal, according to a systematic review and meta-analysis published in JAMA.
The annual risk of stroke decreased from 5.9% in the first year to an average of 1.8% per year thereafter. However, the cumulative risk of stroke continued to increase over time. Notably, half of all subsequent strokes occurred after the first year.
“This risk of subsequent stroke events is high but is not readily apparent in routine clinical practice due to its gradual onset over time,” wrote Faizan Khan, PhD, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, and colleagues. “Given that many secondary prevention clinics only monitor patients for the first 90 days, with long-term preventive care often transitioning to primary care physicians and internists, the current findings emphasise the importance of ongoing vigilant monitoring and risk reduction strategies beyond the initial high-risk period.”
The analysis involved 171,068 patients from 38 studies. The patient population consisted of TIA or minor stroke in 17 studies, TIA only in 20 studies, and minor stroke only in 1 study. There were 24 studies that reported the primary outcome of stroke beyond 1 year of follow-up, 12 studies that reported stroke beyond 5 years of follow-up, and 10 studies that reported stroke up to 10 years of follow-up
The pooled rate of stroke per 100 person-years was 5.94 events (38 studies; I2 = 97%) in the first year; 1.80 events (25 studies; I2 = 90%) annually in the second through fifth years; and 1.72 events (12 studies; I2 = 84%) annually in the sixth through tenth years.
Based on an analysis of 32 included studies with data available for the first 90 days, and day 91 through 365 separately, 2,932 of 4,749 (61.7%) subsequent stroke events in the first year occurred within the initial 90 days. The pooled rate of stroke per 100 person-years was 16.09 events in the first 90 days and 3.04 events between 91 and 365 days.
Among the 10 included studies with a maximum follow-up duration of 10 years, 1,707 of 3,390 (50.4%) subsequent stroke events occurred after the first year. The 5- and 10-year cumulative incidences of stroke were 12.5% and 19.8%, respectively.
Based on an analysis of 17 included studies with data available on both fatal stroke (n = 269) and any stroke (n = 2,737), the pooled case-fatality rate of subsequent stroke was 10.4%.
Stroke rates were higher in studies conducted in North America and Asia compared with Europe, in cohorts recruited in or after 2007, and in studies that used active versus passive outcome ascertainment methods. According to the authors, the fact that the risk of subsequent stroke after a TIA or minor stroke appears to have increased in the modern era deserves attention and further research.
“Patients who have had a TIA or minor stroke are at a persistently high risk of experiencing a subsequent stroke,” the authors concluded. “TIA or minor stroke events also portend a significant risk of long-term disability and death. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient population.”
Reference: https://jamanetwork.com/journals/jama/fullarticle/2832005
SOURCE: JAMA
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