Early Recurrence of Cerebrovascular Events After Transient Ischaemic Attack

Early Recurrence of Cerebrovascular Events After Transient Ischaemic Attack To the Editor: We read with great interest the recent article by Lisabeth et al1 regarding the stroke risk after a transient ischemic attack (TIA). Their results are similar to those reported in the midand late-1990s2,3 and considerably lower than more recent studies reported in the UK4,5 and Canada.6 We run rapid access TIA clinics for the assessment and investigation of individuals referred by their general practitioner following a suspected cerebrovascular event that has not necessitated in-patient management. During a recent audit of this service we examined the rate of recurrent cerebrovascular events in new referrals over a 6-month period, to 2 hospitals in East Glasgow, Scotland. Information was obtained from the referral letter, clinic letters, health care practices, hospital records and investigating departments. Of 372 new referrals to the clinics, 37 (10%) did not attend, 130 (35%) had a non-cerebrovascular diagnosis, and 205 (55%) were deemed to have suffered a probable or definite new TIA (121 [32.5%]) or minor stroke (84 [22.5%]). There were 19 documented recurrent cerebrovascular events in this group giving a crude recurrence rate of 9% (95% CI, 5 to 13%), of which 10 cases (5%; 95% CI, 2 to 8%) were known to have occurred within one week, and 15 (7%; 95% CI, 4 to 11%) within one month of the initial episode. Of the patients who had an initial diagnosis of TIA there were 17 recurrent events (14%; 95% CI 8 to 20%), with 7 cases (6%; 95% CI 1 to 10%) occurring within one week, and 13 (11%; 95% CI 5 to 16%) within one month. Multivariate analysis identified current cigarette smoking as the only independent risk factor for a recurrent event. Our findings are more similar to those of Coull et al5 and Johnston et al6 and raise the concern that very early recurrence is a significant problem that will continue to grow in tandem with an ageing population. Although, it is presently unclear whether secondary preventative measures can reduce these early recurrent events, future research should be directed toward identifying the medical and organizational strategies that would best reduce the risk of such events.