Walter N. Kernan, MD; Ralph I. Horwitz, MD; Lawrence M. Brass, MD; Catherine M. Viscoli, PhD; Kenneth J. W. Taylor, MD, PhD
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.
Kernan WN, Horwitz RI, Brass LM, Viscoli CM, Taylor KJW. A Prognostic System for Transient Ischemia or Minor Stroke. Ann Intern Med. ;114:552–557. doi: 10.7326/0003-4819-114-7-552
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Published: Ann Intern Med. 1991;114(7):552-557.
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