NORTHSTAR
Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England
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Status:
Completed. Results published November 2007.
Purpose:
To investigate the use of the ABCD2 Score and the prognostic role of peripheral and genetic inflammatory markers in patients with recent TIA or minor stroke.
Year Started:
2003
Year Finished:
2006
Design:
Prospective, multi-center, nested, case-controlled, assigned treatment study.
Inclusion Criteria
Diagnosis of TIA or minor stroke confirmed by a consultant stroke physician or neurologist; modified Rankin Scale (mRS) <1; no known cognitive impairment sufficient to interfere with independent daily living; no significant comorbidity limiting participation in the study; intention to remain resident within the area for the duration of the study, with access to a telephone.
Exclusion Criteria
Patients with pre-existing significant physical disabilities and/or cognitive impairment.
Patient Involvement:
Baseline data, including date and duration of symptoms, past medical history, vascular risk factors, current medications, mRS, Barthel Index (BI), blood pressure (BP) and ECG were recorded at study entry. Investigation and secondary
prevention were then initiated at the discretion of the clinician responsible for the patient, with ABCD scores assigned retrospectively using clinical information collected at the time of recruitment. Follow up with survivors 3 months later in person or by phone to obtain primary outcome measures.
Primary Outcome:
Number of incidents of TIA, stroke, acute coronary syndrome or cardiovascular mortality at 3 month follow-up.
Secondary Outcome:
Incident strokes occurring during follow-up.
Results:
Median duration from the index TIA to the primary outcome event was 15 (0-42) days, with primary outcome events occurring in 126 (18%) patients. 100 (79.4% of the events) of these primary outcome events were TIA's, 25 (19.8%) were non-fatal strokes, and 1 (0.8%) was a cardiovascular death. A further 59 events occurred in 39 of the patients, with 30 fatal or non-fatal incident strokes occurring in 29 (4%) of the patients overall, and stroke accounting for 20% of the primary outcome events.
In multifactorial analyses, the ABCD2 score was unrelated to the risk of the primary outcome, in spite of its significant relationship to incident stroke. The presence of unilateral weakness and symptom duration of 1 h or more, accounted for the relationship between the ABCD2 score and stroke risk, thus, age, speech disturbance or diabetes mellitus were not associated with stroke risk. Of all components, only unilateral weakness was found to significantly increase the risk of the subsequent primary outcome event (HR 1.8).
Source of Information:
J Neurol Neurosurg Psychiatry. 2007 Nov 22; [Epub ahead of print].
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This information last updated on: 11/24/2007
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