Shadi Yaghi1, Sara K Rostanski2, Amelia K Boehme2, Sheryl Martin-Schild3, Alyana Samai3, Brian Silver1, Christina A Blum1, Mahesh V Jayaraman4, Matthew S Siket5, Muhib Khan1, Karen L Furie1, Mitchell S V Elkind6, Randolph S Marshall2, Joshua Z Willey2. 1. Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 2. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York. 3. Department of Neurology, Tulane University, New Orleans, Louisiana. 4. Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island 4Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 5. Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island. 6. Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York6Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Abstract
IMPORTANCE: Neurological worsening and recurrent stroke contribute substantially to morbidity associated with transient ischemic attacks and strokes (TIA-S). OBJECTIVE: To determine predictors of early recurrent cerebrovascular events (RCVEs) among patients with TIA-S and National Institutes of Health Stroke Scale scores of 0 to 3. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 2 tertiary care centers (Columbia University Medical Center, New York, New York, and Tulane University Medical Center, New Orleans, Louisiana) between January 1, 2010, and December 31, 2014. All patients with neurologist-diagnosed TIA-S with a National Institutes of Health Stroke Scale score of 0 to 3 who presented to the emergency department were included. MAIN OUTCOMES AND MEASURES: The primary outcome (adjudicated by 3 vascular neurologists) was RCVE: neurological deterioration in the absence of a medical explanation or recurrent TIA-S during hospitalization. RESULTS: Of the 1258 total patients, 1187 had no RCVEs and 71 had RCVEs; of this group, 750 patients (63.2%) and 39 patients (54.9%), respectively, were aged 60 years or older. There were 505 patients with TIA-S at Columbia University; 31 (6.1%) had RCVEs (15 patients had neurological deterioration only, 11 had recurrent TIA-S only, and 5 had both). The validation cohort at Tulane University consisted of 753 patients; 40 (5.3%) had RCVEs (24 patients had neurological deterioration only and 16 had both). Predictors of RCVE in multivariate models in both cohorts were infarct on neuroimaging (computed tomographic scan or diffusion-weighted imaging sequences on magnetic resonance imaging) (Columbia University: not applicable and Tulane University: odds ratio, 1.75; 95% CI, 0.82-3.74; P = .15) and large-vessel disease etiology (Columbia University: odds ratio, 6.69; 95% CI, 3.10-14.50 and Tulane University: odds ratio, 8.13; 95% CI, 3.86-17.12; P < .001). There was an increase in the percentage of patients with RCVEs when both predictors were present. When neither predictor was present, the rate of RCVE was extremely low (up to 2%). Patients with RCVEs were less likely to be discharged home in both cohorts. CONCLUSIONS AND RELEVANCE: In patients with minor stroke, vessel imaging and perhaps neuroimaging parameters, but not clinical scores, were associated with RCVEs in 2 independent data sets. Prospective studies are needed to validate these predictors.
IMPORTANCE: Neurological worsening and recurrent stroke contribute substantially to morbidity associated with transient ischemic attacks and strokes (TIA-S). OBJECTIVE: To determine predictors of early recurrent cerebrovascular events (RCVEs) among patients with TIA-S and National Institutes of Health Stroke Scale scores of 0 to 3. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at 2 tertiary care centers (Columbia University Medical Center, New York, New York, and Tulane University Medical Center, New Orleans, Louisiana) between January 1, 2010, and December 31, 2014. All patients with neurologist-diagnosed TIA-S with a National Institutes of Health Stroke Scale score of 0 to 3 who presented to the emergency department were included. MAIN OUTCOMES AND MEASURES: The primary outcome (adjudicated by 3 vascular neurologists) was RCVE: neurological deterioration in the absence of a medical explanation or recurrent TIA-S during hospitalization. RESULTS: Of the 1258 total patients, 1187 had no RCVEs and 71 had RCVEs; of this group, 750 patients (63.2%) and 39 patients (54.9%), respectively, were aged 60 years or older. There were 505 patients with TIA-S at Columbia University; 31 (6.1%) had RCVEs (15 patients had neurological deterioration only, 11 had recurrent TIA-S only, and 5 had both). The validation cohort at Tulane University consisted of 753 patients; 40 (5.3%) had RCVEs (24 patients had neurological deterioration only and 16 had both). Predictors of RCVE in multivariate models in both cohorts were infarct on neuroimaging (computed tomographic scan or diffusion-weighted imaging sequences on magnetic resonance imaging) (Columbia University: not applicable and Tulane University: odds ratio, 1.75; 95% CI, 0.82-3.74; P = .15) and large-vessel disease etiology (Columbia University: odds ratio, 6.69; 95% CI, 3.10-14.50 and Tulane University: odds ratio, 8.13; 95% CI, 3.86-17.12; P < .001). There was an increase in the percentage of patients with RCVEs when both predictors were present. When neither predictor was present, the rate of RCVE was extremely low (up to 2%). Patients with RCVEs were less likely to be discharged home in both cohorts. CONCLUSIONS AND RELEVANCE: In patients with minor stroke, vessel imaging and perhaps neuroimaging parameters, but not clinical scores, were associated with RCVEs in 2 independent data sets. Prospective studies are needed to validate these predictors.
Authors: Matthew F Giles; Greg W Albers; Pierre Amarenco; Murat M Arsava; Andrew Asimos; Hakan Ay; David Calvet; Shelagh Coutts; Brett L Cucchiara; Andrew M Demchuk; S Claiborne Johnston; Peter J Kelly; Anthony S Kim; Julien Labreuche; Philippa C Lavallee; Jean-Louis Mas; Aine Merwick; Jean Marc Olivot; Francisco Purroy; Wayne D Rosamond; Rossella Sciolla; Peter M Rothwell Journal: Stroke Date: 2010-07-15 Impact factor: 7.914
Authors: Orla C Sheehan; Lorraine Kyne; Lisa A Kelly; Niamh Hannon; Michael Marnane; Aine Merwick; Patricia M E McCormack; Joseph Duggan; Alan Moore; Joan Moroney; Leslie Daly; Dawn Harris; Gillian Horgan; Emma B Williams; Peter J Kelly Journal: Stroke Date: 2010-03-18 Impact factor: 7.914
Authors: F Purroy; P E Jiménez-Caballero; G Mauri-Capdevila; M J Torres; A Gorospe; J M Ramírez Moreno; N P de la Ossa; D Cánovas; J Arenillas; J Alvarez-Sabín; P Martínez Sánchez; B Fuentes; R Delgado-Mederos; J Martí-Fàbregas; A Rodríguez Campello; J Masjuán Journal: Eur J Neurol Date: 2013-03-26 Impact factor: 6.089
Authors: Hebun Erdur; Jan F Scheitz; Martin Ebinger; Andrea Rocco; Ulrike Grittner; Andreas Meisel; Peter M Rothwell; Matthias Endres; Christian H Nolte Journal: Stroke Date: 2015-03-03 Impact factor: 7.914
Authors: V Rajajee; C Kidwell; S Starkman; B Ovbiagele; J R Alger; P Villablanca; F Vinuela; G Duckwiler; R Jahan; A Fredieu; S Suzuki; J L Saver Journal: Neurology Date: 2006-09-26 Impact factor: 9.910
Authors: S Claiborne Johnston; J Donald Easton; Mary Farrant; William Barsan; Holly Battenhouse; Robin Conwit; Catherine Dillon; Jordan Elm; Anne Lindblad; Lewis Morgenstern; Sharon N Poisson; Yuko Palesch Journal: Int J Stroke Date: 2013-08 Impact factor: 5.266
Authors: Ava L Liberman; Ali Zandieh; Caitlin Loomis; Jonathan M Raser-Schramm; Christina A Wilson; Jose Torres; Koto Ishida; Swaroop Pawar; Rebecca Davis; Michael T Mullen; Steven R Messé; Scott E Kasner; Brett L Cucchiara Journal: Stroke Date: 2017-01-11 Impact factor: 7.914
Authors: Mario Zanaty; James D Rossen; Jorge A Roa; Daichi Nakagawa; Joseph S Hudson; Sami Al Kasab; Kaustubh Limaye; Khaled Asi; Sudeepta Dandapat; Pascal Jabbour; Edgar A Samaniego; David M Hasan Journal: Oper Neurosurg (Hagerstown) Date: 2020-06-01 Impact factor: 2.703
Authors: Bernard P Chang; Sara Rostanski; Joshua Willey; Eliza C Miller; Steven Shapiro; Rachel Mehendale; Benjamin Kummer; Babak B Navi; Mitchell S V Elkind Journal: Ann Emerg Med Date: 2019-07-17 Impact factor: 5.721
Authors: Adam de Havenon; Pooja Khatri; Shyam Prabhakaran; Sharon D Yeatts; Cecilia Peterson; Daniel Sacchetti; Matthew Alexander; Shawna Cutting; Brian Mac Grory; Karen Furie; David S Liebeskind; Shadi Yaghi Journal: J Neuroimaging Date: 2020-06-24 Impact factor: 2.486
Authors: Shadi Yaghi; Adam de Havenon; Tristan Honda; Jason D Hinman; Radoslav Raychev; Latisha K Sharma; Song Kim; Edward Feldmann; Jose G Romano; Shyam Prabhakaran; David S Liebeskind Journal: J Neuroimaging Date: 2021-02-10 Impact factor: 2.486
Authors: Seemant Chaturvedi; Susan Ofner; Fitsum Baye; Laura J Myers; Mike Phipps; Jason J Sico; Teresa Damush; Edward Miech; Mat Reeves; Jason Johanning; Linda S Williams; Greg Arling; Eric Cheng; Zhangsheng Yu; Dawn Bravata Journal: Neurology Date: 2016-12-07 Impact factor: 9.910