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A Prognostic System for Transient Ischemia or Minor Stroke

Walter N. Kernan, MD; Ralph I. Horwitz, MD; Lawrence M. Brass, MD; Catherine M. Viscoli, PhD; and Kenneth J. W. Taylor, MD, PhD
[+] Article, Author, and Disclosure Information

Grant Support: During the study period, Dr. Kernan was a Robert Wood Johnson Clinical Scholar at Yale University.

Requests for Reprints: Walter N. Kernan, MD, Primary Care Center, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504.

Current Author Addresses: Dr. Kernan: Primary Care Center, Yale-New Haven Hospital, 20 York Street, New Haven, CT 06504.

Drs. Horwitz and Viscoli: Section of General Medicine, IE 61 SHM, Yale University School of Medicine, Box 3333, New Haven, CT 06510. Dr. Brass: LCI 701, Department of Neurology, Yale University School of Medicine, Box 3333, New Haven, CT 06510.

Dr. Taylor: Tompkins 2E, Department of Diagnostic Imaging, Yale-New Haven Hospital, 20 York Street, New Haven CT 06504.

©1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(7):552-557. doi:10.7326/0003-4819-114-7-552
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Objective: To build a prognostic system for patients with carotid transient ischemic attack or minor stroke.

Design: Inception cohort study with 2-year follow-up.

Setting: Urban community teaching hospital.

Patients: Eligible patients (n = 142), identified on a carotid ultrasound roster, had been hospitalized between 1984 and 1987 within 30 days of a first carotid transient ischemic attack or minor stroke.

Measurements: Stroke or death within 2 years.

Main Results: Three factors were associated with stroke or death: age of more than 65 years, diabetes, and hypertension. Based on regression coefficients, age of more than 65 years was assigned 3 points; diabetes, 3 points; and hypertension, 2 points. An initial prognostic system comprised risk groups 1 (0 points), 2 (1 to 5 points), and 3 (6 to 8 points). Outcome rates in the three groups were 2%, 31%, and 54% (P < 0.0001), respectively. In an independent test sample, the corresponding outcome rates for the initial system were 12%, 21%, and 31% (P = 0.04). A final prognostic system, including two additional predictors (coronary heart disease [1 point] and the distinction between stroke and transient ischemic attack for the baseline event [2 points]), comprised risk groups 1 (0 to 2 points), 2 (3 to 6 points), and 3 (7 to 11 points). Corresponding outcome rates were 3%, 27%, and 48% (P < 0.001) in the original cohort and 10%, 21%, and 59% (P < 0.001) in the test cohort.

Conclusion: For selected patients with carotid transient ischemia or minor stroke, five clinical features can be combined to stratify effectively the risk for a subsequent stroke or death.





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