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Risk of major vascular events in patients without traditional risk factors after transient ischemic attack or minor ischemic stroke: an international prospective cohort

Introduction: To investigate the clinical characteristics in patients without traditional risk factors (TRFs) after transient ischemic attack or minor ischemic stroke, who were recruited in the TIAregistry.org. - Patients and methods: A total of 3847 patients were analyzed. TRFs included hypertensio...

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Main Authors: Uchiyama, Shinichiro (Author) , Hoshino, Takao (Author) , Minematsu, Kazuo (Author) , Meledje, Marie-Laure (Author) , Charles, Hugo (Author) , Albers, Gregory W (Author) , Caplan, Louis R (Author) , Donnan, Geoffrey A (Author) , Ferro, José M (Author) , Hennerici, Michael G. (Author) , Molina, Carlos (Author) , Rothwell, Peter M (Author) , Wong, Lawrence KS (Author) , Amarenco, Pierre (Author)
Format: Article (Journal)
Language:English
Published: June 2025
In: European stroke journal
Year: 2025, Volume: 10, Issue: 2, Pages: 531-540
ISSN:2396-9881
DOI:10.1177/23969873241300071
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873241300071
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Author Notes:Shinichiro Uchiyama, Takao Hoshino, Kazuo Minematsu, Marie-Laure Meledje, Hugo Charles, Gregory W Albers, Louis R Caplan, Geoffrey A Donnan, José M Ferro, Michael G Hennerici, Carlos Molina, Peter M Rothwell, Lawrence KS Wong, and Pierre Amarenco, on behalf of the TIAregistry.org Investigators
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Summary:Introduction: To investigate the clinical characteristics in patients without traditional risk factors (TRFs) after transient ischemic attack or minor ischemic stroke, who were recruited in the TIAregistry.org. - Patients and methods: A total of 3847 patients were analyzed. TRFs included hypertension, diabetes, hypercholesterolemia, current smoking, and atrial fibrillation. Background characteristics and outcomes at 1 and 5 years in patients without TRFs were compared to those in patients with TRFs. The primary outcome was major cardiovascular event (MACE), which was non-fatal stroke, non-fatal acute coronary syndrome, or vascular death. To evaluate the causes, we applied the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other causes or dissection) grading system. - Results: One-year risk of MACE (5.3% vs 6.3%, hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.53-1.31) was comparable between patients without TRFs (n = 402) and those with TRFs (n = 3445). Five-year risk of MACE was significantly lower in patients without TRFs than in those with TRFs (7.9% vs 13.9%, HR 0.57, 95% CI 0.39-0.82). In patients without TRFs, causal atherosclerosis was a potent risk factor (HR 5.67, 95% CI 2.68-12.02) and ipsilateral extra- or intra-cranial arterial stenosis was only significant predictor of MACE (interaction p = 0.0046) at 5 years. - Conclusion and discussion: The 5-year risk of MACE was lower in patients without TRFs than those with TRFs, although a certain level of risk persisted in the absence of TRFs. The most significant predictor of MACE in patients without TRFs was arterial stenosis.
Item Description:Online veröffentlicht: 21. November 2024
Gesehen am 24.09.2025
Physical Description:Online Resource
ISSN:2396-9881
DOI:10.1177/23969873241300071

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