Predictive Value of Clinical History and Electrocardiogram in Patients With Transient Ischemic Attack or Minor Ischemic Stroke for Subsequent Cardiac and Cerebral Ischemic Events
Gheorghe A. M. Pop, MD;
Peter J. Koudstaal, MD;
Han J. Meeder, MD;
Ale Algra, MD;
Jeanette C. van Latum, MD;
Jan van Gijn, MD;
Dutch TIA Trial Study Group
Arch Neurol. 1994;51(4):333-341.
Abstract
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Objective
Patients with cerebral ischemia have a high mortality rate. The most common cause of death is myocardial infarction. We attempted to identify risk factors for subsequent cardiac events in patients with cerebral ischemia by means of the history and electrocardiography performed with the patient at rest.
Design
The original inception cohort was entered in a multicenter randomized clinical trial (30 or 283 mg/d of aspirin) and followed up prospectively for a mean period of 2.6 years.
Setting
Patients were admitted to the hospital or seen in outpatient clinics.
Patients
Patients with one or more transient ischemic attacks (symptoms completely reversible within 24 hours) and patients with minor ischemic stroke (symptoms persisting for longer than 24 hours) were randomized, provided they were independent in most activities of daily living. Patients with a definite or probable source of embolism in the heart were excluded. A total of 3021 patients were included in the study. Follow-up was performed at 4-month intervals.
Main Outcome Measures
Primary cardiac outcome events were defined as nonfatal myocardial infarction and cardiac death. Cardiac death included sudden death, fatal myocardial infarction, or death due to congestive heart failure; 189 patients suffered a cardiac death—82 of which were sudden deaths—or nonfatal myocardial infarction.
Results
By means of multivariate analysis, the following independent predictors for cardiac events were identified (hazards ratio/95% confidence limits): age older than 65 years (1.6/1.2 to 2.2), male sex (1.5/1.1 to 2.1), angina pectoris (1.5/1.0 to 2.3), diabetes (1.6/1.1 to 2.5), anterior infarction noted on electrocardiography (1.7/1.1 to 2.7), inverted T wave noted on the electrocardiogram (1.6/1.1 to 2.4), and left ventricular hypertrophy noted on electrocardiography (3.2/2.0 to 4.9).
Conclusions
The history and the electrocardiogram obtained with the patient at rest are valuable tools for cardiac risk assessment in patients with recent cerebral ischemia.
Author Affiliations
From the Departments of Cardiology (Dr Pop), Neurology (Drs Koudstaal and van Latum), and Anesthesiology (Dr Meeder), University Hospital Rotterdam-Dijkzigt (the Netherlands), and the Department of Neurology, University Hospital Utrecht (the Netherlands) (Drs Algra and van Gijn). The other investigators and the participating centers of the Dutch TIA Trial Study Group are listed elsewhere.14
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