TY - JOUR
T1 - Long-Term Risk of Stroke After Transient Ischemic Attack or Minor Stroke A Systematic Review and Meta-Analysis
AU - Khan, Faizan
AU - Yogendrakumar, Vignan
AU - Writing Committee for the PERSIST Collaborators
AU - Lun, Ronda
AU - Ganesh, Aravind
AU - Barber, Philip A.
AU - Lioutas, Vasileios Arsenios
AU - Vinding, Naja Emborg
AU - Algra, Ale
AU - Weimar, Christian
AU - Ögren, Joachim
AU - Edwards, Jodi D.
AU - Swartz, Richard H.
AU - Ois, Angel
AU - Giralt-Steinhauer, Eva
AU - Khanevski, Andrej Netland
AU - Leng, Xinyi
AU - Tian, Xuan
AU - Leung, Thomas W.
AU - Park, Hong Kyun
AU - Bae, Hee Joon
AU - Kamouchi, Masahiro
AU - Ago, Tetsuro
AU - Verburgt, Esmee
AU - Verhoeven, Jamie
AU - de Leeuw, Frank Erik
AU - Berghout, Bernhard P.
AU - Ikram, M. Kamran
AU - Kostev, Karel
AU - Whiteley, William
AU - Uehara, Toshiyuki
AU - Minematsu, Kazuo
AU - Ildstad, Fredrik
AU - Fandler-Höfler, Simon
AU - Aarnio, Karoliina
AU - von Sarnowski, Bettina
AU - Foschi, Matteo
AU - Jing, Jing
AU - Baik, Minyoul
AU - Kim, Young Dae
AU - Spampinato, Michele Domenico
AU - Hasegawa, Yasuhiro
AU - Perera, Kanjana
AU - Purroy, Francisco
AU - Dutta, Dipankar
AU - Yang, Xiaoli
AU - Lippert, Julian
AU - Myers, Laura
AU - Bravata, Dawn M.
AU - Santos, Monica
AU - Coveney, Sarah
N1 - Publisher Copyright:
© 2025 American Medical Association. All rights reserved.
PY - 2025/5/6
Y1 - 2025/5/6
N2 - IMPORTANCE:After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke is not well-known. OBJECTIVE: To determine the annual incidence rates and cumulative incidences of stroke up to 10 years after TIA or minor stroke. DATA SOURCES:Medline Embase, and Web of Science were searched from inception through June 26, 2024. STUDY SELECTION:Prospective or retrospective cohort studies reporting stroke risk during a minimum follow-up of 1 year in patients with TIA or minor stroke. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently performed data extraction and assessed study quality. Unpublished aggregate-level data on number of events and person-years during discrete follow-up intervals were obtained directly from the authors of the included studies to calculate incidence rates in individual studies. Data across studies were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: The primary outcome was any stroke. Study-level characteristics were investigated as potential sources of variability in stroke rates across studies. RESULTS: The analysis involved 171 068 patients (median age, 69 years [IQR, 65-71]; median proportion of male patients, 57% [IQR, 52%-60%]) from 38 included studies. The pooled rate of stroke per 100 person-years was 5.94 events (95% CI, 5.18-6.76; 38 studies; I2 = 97%) in the first year, 1.80 events (95% CI, 1.58-2.04; 25 studies; I2 = 90%) annually in the second through fifth years, and 1.72 events (95% CI, 1.31-2.18; 12 studies; I2 = 84%) annually in the sixth through tenth years. The 5- and 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.0%-14.1%) and 19.8% (95% CI, 16.7%-23.1%), respectively. Stroke rates were higher in studies conducted in North America (rate ratio [RR], 1.43 [95% CI, 1.36-1.50]) and Asia (RR, 1.62 [95% CI, 1.52-1.73]), compared with Europe, in cohorts recruited in or after 2007 (RR, 1.42 [95% CI, 1.23-1.64]), and in studies that used active vs passive outcome ascertainment methods (RR, 1.11 [95% CI, 1.07-1.17]). Studies focusing solely on patients with TIA (RR, 0.68 [95% CI, 0.65-0.71) or first-ever index events (RR, 0.45 [95% CI, 0.42-0.49]) had lower stroke rates than studies with an unselected patient population. CONCLUSIONS AND RELEVANCE:Patients who have had a TIA or minor stroke are at a persistently high risk of subsequent stroke. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient group.
AB - IMPORTANCE:After a transient ischemic attack (TIA) or minor stroke, the long-term risk of stroke is not well-known. OBJECTIVE: To determine the annual incidence rates and cumulative incidences of stroke up to 10 years after TIA or minor stroke. DATA SOURCES:Medline Embase, and Web of Science were searched from inception through June 26, 2024. STUDY SELECTION:Prospective or retrospective cohort studies reporting stroke risk during a minimum follow-up of 1 year in patients with TIA or minor stroke. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently performed data extraction and assessed study quality. Unpublished aggregate-level data on number of events and person-years during discrete follow-up intervals were obtained directly from the authors of the included studies to calculate incidence rates in individual studies. Data across studies were pooled using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: The primary outcome was any stroke. Study-level characteristics were investigated as potential sources of variability in stroke rates across studies. RESULTS: The analysis involved 171 068 patients (median age, 69 years [IQR, 65-71]; median proportion of male patients, 57% [IQR, 52%-60%]) from 38 included studies. The pooled rate of stroke per 100 person-years was 5.94 events (95% CI, 5.18-6.76; 38 studies; I2 = 97%) in the first year, 1.80 events (95% CI, 1.58-2.04; 25 studies; I2 = 90%) annually in the second through fifth years, and 1.72 events (95% CI, 1.31-2.18; 12 studies; I2 = 84%) annually in the sixth through tenth years. The 5- and 10-year cumulative incidence of stroke was 12.5% (95% CI, 11.0%-14.1%) and 19.8% (95% CI, 16.7%-23.1%), respectively. Stroke rates were higher in studies conducted in North America (rate ratio [RR], 1.43 [95% CI, 1.36-1.50]) and Asia (RR, 1.62 [95% CI, 1.52-1.73]), compared with Europe, in cohorts recruited in or after 2007 (RR, 1.42 [95% CI, 1.23-1.64]), and in studies that used active vs passive outcome ascertainment methods (RR, 1.11 [95% CI, 1.07-1.17]). Studies focusing solely on patients with TIA (RR, 0.68 [95% CI, 0.65-0.71) or first-ever index events (RR, 0.45 [95% CI, 0.42-0.49]) had lower stroke rates than studies with an unselected patient population. CONCLUSIONS AND RELEVANCE:Patients who have had a TIA or minor stroke are at a persistently high risk of subsequent stroke. Findings from this study underscore the need for improving long-term stroke prevention measures in this patient group.
UR - https://www.scopus.com/pages/publications/105002762808
U2 - 10.1001/jama.2025.2033
DO - 10.1001/jama.2025.2033
M3 - Article
C2 - 40136306
AN - SCOPUS:105002762808
SN - 0098-7484
VL - 333
SP - 1508
EP - 1519
JO - JAMA
JF - JAMA
IS - 17
ER -