Jamie Clarey1, Daniel Lasserson2, Christopher Levi3, Mark Parsons4, Helen Dewey5, P Alan Barber6, Debbie Quain7, Patrick McElduff7, Milton Sales8, Parker Magin9. 1. Discipline of General Practice, University of Newcastle, Newcastle, Australia. 2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 3. Centre for Translational Neuroscience, University of Newcastle, Newcastle, Department of Neurology, John Hunter Hospital, Newcastle. 4. Department of Neurology, John Hunter Hospital, Newcastle, School of Medicine and Public Health, University of Newcastle, Newcastle. 5. Department of Medicine - Austin Health, University of Melbourne, Melbourne, Australia. 6. Centre for Brain Research Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand and. 7. School of Medicine and Public Health, University of Newcastle, Newcastle. 8. General Practice Training valley to coast, Newcastle, Australia. 9. Discipline of General Practice, University of Newcastle, Newcastle, Australia, Centre for Translational Neuroscience, University of Newcastle, Newcastle, General Practice Training valley to coast, Newcastle, Australia. parker.magin@newcastle.edu.au.
Abstract
BACKGROUND: Transient ischaemic attacks (TIA) and minor strokes (TIAMS) have the same pathophysiological mechanism as stroke and carry a high risk of recurrent ischaemic events. Diagnosis of TIAMS can be challenging and often occurs in general practice. Absolute cardiovascular risk (ACVR) is recommended as the basis for vascular risk management. Consideration of cardiovascular risk in TIAMS diagnosis has been recommended but its utility is not established. OBJECTIVES: Firstly, to document the ACVR of patients with incident TIAMS and with TIAMS-mimics. Secondly, to evaluate the utility of ACVR calculation in informing the initial diagnosis of TIAMS. METHODS: The International comparison of Systems of care and patient outcomes in minor Stroke and TIA (InSiST) study is an inception cohort study of patients of 17 Australian general practices presenting as possible TIAMS. An expert panel determines whether participants have had TIAMS or TIAMS-mimics. ACVR was calculated at baseline for each participating patient. In this cross-sectional baseline analysis, ACVR of TIAMS and TIAMS-mimics were compared univariately and, also, when adjusted for age and sex. The diagnostic utility of ACVR was evaluated via receiver operating characteristic (ROC) curves. RESULTS: Of 179 participants, 87 were adjudicated as TIAMS. The presence of motor and speech symptoms and body mass index were associated with a diagnosis of TIAMS. ACVR was associated with TIAMS diagnosis on univariate analysis, but not when age- and sex-adjusted. ACVR did not significantly improve area under ROC curves beyond that of age and sex. CONCLUSION: In patients presenting with transient or minor neurological symptoms, calculation of ACVR did not improve diagnostic accuracy for TIAMS beyond that of age and sex.
BACKGROUND: Transient ischaemic attacks (TIA) and minor strokes (TIAMS) have the same pathophysiological mechanism as stroke and carry a high risk of recurrent ischaemic events. Diagnosis of TIAMS can be challenging and often occurs in general practice. Absolute cardiovascular risk (ACVR) is recommended as the basis for vascular risk management. Consideration of cardiovascular risk in TIAMS diagnosis has been recommended but its utility is not established. OBJECTIVES: Firstly, to document the ACVR of patients with incident TIAMS and with TIAMS-mimics. Secondly, to evaluate the utility of ACVR calculation in informing the initial diagnosis of TIAMS. METHODS: The International comparison of Systems of care and patient outcomes in minor Stroke and TIA (InSiST) study is an inception cohort study of patients of 17 Australian general practices presenting as possible TIAMS. An expert panel determines whether participants have had TIAMS or TIAMS-mimics. ACVR was calculated at baseline for each participating patient. In this cross-sectional baseline analysis, ACVR of TIAMS and TIAMS-mimics were compared univariately and, also, when adjusted for age and sex. The diagnostic utility of ACVR was evaluated via receiver operating characteristic (ROC) curves. RESULTS: Of 179 participants, 87 were adjudicated as TIAMS. The presence of motor and speech symptoms and body mass index were associated with a diagnosis of TIAMS. ACVR was associated with TIAMS diagnosis on univariate analysis, but not when age- and sex-adjusted. ACVR did not significantly improve area under ROC curves beyond that of age and sex. CONCLUSION: In patients presenting with transient or minor neurological symptoms, calculation of ACVR did not improve diagnostic accuracy for TIAMS beyond that of age and sex.
Authors: Orla C Sheehan; Aine Merwick; Lisa A Kelly; Niamh Hannon; Michael Marnane; Lorraine Kyne; Patricia M E McCormack; Joseph Duggan; Alan Moore; Joan Moroney; Leslie Daly; Dawn Harris; Gillian Horgan; Peter J Kelly Journal: Stroke Date: 2009-09-10 Impact factor: 7.914
Authors: Parker Magin; Daniel Lasserson; Mark Parsons; Neil Spratt; Malcolm Evans; Michelle Russell; Angela Royan; Susan Goode; Patrick McElduff; Christopher Levi Journal: Int J Stroke Date: 2013-03-12 Impact factor: 5.266
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Andrew Wilson; Dawn Coleby; Emma Regen; Kay Phelps; Kate Windridge; Janet Willars; Tom Robinson Journal: BMJ Open Date: 2016-05-17 Impact factor: 2.692