Clinical Question: What is the likelihood of serious nonstroke health outcomes following transient ischemic attacks or strokes?
Setting: Inpatient (any location) with outpatient follow-up
Study Design: Meta-analysis (other)
Synopsis: Researchers searched the MEDLINE and Cochrane databases to identify English-language systematic reviews, randomized trials, and prospective cohort studies published after 1980 that monitored 100 or more patients for at least one year and accounted for at least 95 percent of the patients. They scanned the bibliographies of all the included studies but did not look for unpublished studies. Two members of the research team independently determined study eligibility and extracted the data. They resolved disagreements by discussion and consensus.
Based on the 39 eligible studies with nearly 66,000 patients, the yearly rates of nonstroke vascular death (2.1 percent), total myocardial infarctions (MI) (2.2 percent), fatal MI (1.1 percent), and nonfatal MI (0.9 percent) were fairly constant over time, but there was much variation in these rates in the different studies. Baseline characteristics of the study participants did not seem to be the source of the heterogeneity.
Bottom Line: Following a stroke or transient ischemic attack, the annual rate of nonstroke vascular death and MI is approximately 2 percent per year. This information can be used to inform patients about the clinical course of their disease. (Level of Evidence: 1a)