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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1407598
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 60 articles

Enhancing Stroke Risk Prediction in Patients with Transient Ischemic Attack: Insights from a Prospective Cohort Study Implementing Fast-Track Care

Provisionally accepted
Valentina Barone Valentina Barone 1Matteo Foschi Matteo Foschi 2,3Lucia Pavolucci Lucia Pavolucci 3Francesca Rondelli Francesca Rondelli 1Rita Rinaldi Rita Rinaldi 1Marianna Nicodemo Marianna Nicodemo 1Roberto D'Angelo Roberto D'Angelo 1Elisabetta Favaretto Elisabetta Favaretto 4Carlotta Brusi Carlotta Brusi 4Benilde Cosmi Benilde Cosmi 4Daniela Degli Esposti Daniela Degli Esposti 5D'Addato Sergio D'Addato Sergio 5,6Stefano Bacchelli Stefano Bacchelli 5Fabrizio Giostra Fabrizio Giostra 7Daniela P. Pomata Daniela P. Pomata 7Luca Spinardi Luca Spinardi 8Luca Faccioli Luca Faccioli 8Gianluca Faggioli Gianluca Faggioli 9Andrea Donti Andrea Donti 7Claudio Borghi Claudio Borghi 5Pietro Cortelli Pietro Cortelli 1,10Maria Guarino Maria Guarino 1*
  • 1 IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
  • 2 Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Abruzzo, Italy
  • 3 Department of Neuroscience, S.Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
  • 4 Angiology and Blood Coagulation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  • 5 Department of Cardio-Thoracic Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  • 6 Department of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Emilia-Romagna, Italy
  • 7 Independent researcher, Bologna, Italy
  • 8 Other, Bologna, Italy
  • 9 Department of Vascular Surgery, DIMEC – University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
  • 10 Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Emilia-Romagna, Italy

The final, formatted version of the article will be published soon.

    Background and aims: Fast-track care have been proved to reduce the short-term risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short-and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management.Methods: Prospective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017. All patients underwent fasttrack care within 24 hours of admission. The primary outcome was defined as the first stroke recurrence at 90 days, 12 and 60 months after TIA. Stroke incidence with 95% confidence interval (CI) at each timepoint was calculated using Poisson regression. Predictors of stroke recurrence were evaluated with Cox regression analysis. The number needed to treat (NNT) of fast-track care in preventing 90-day stroke recurrence in respect to the estimates based on baseline ABCD2 score was also calculated.We enrolled 1035 patients (54.2% males). Stroke incidence was low throughout the follow-up with rates of 2.2% [95% CI 1.4%-3.3%] at 90 days, 2.9% [95% CI 1.9%-4.2%] at 12 months and 7.1% [95% CI 5.4%-9.0%] at 60 months. Multiple TIA, speech disturbances and presence of ischemic lesion at neuroimaging predicted stroke recurrence at each timepoint. Male sex and increasing age predicted 90-day and 60-month stroke risk, respectively. Hypertension was associated with higher 12-month and 60-month stroke risk.No specific TIA etiology predicted higher stroke risk throughout the follow-up. The NNT for fast-track care in preventing 90-day stroke was ] in the overall cohort and 6.8 [95% CI 4.6-13.5] in patients with baseline ABCD2 of 6 to 7.Our findings support the effectiveness of fast-track care in preventing both short-and long-term stroke recurrence after TIA. Particular effort should be made to identify

    Keywords: transient ischemic attack, Stroke, outcomes, Fast-track, predictors, number needed to treat Tables: 4, Figures: 2, Supplementary file: 1 containing 2 supplemental tables

    Received: 26 Mar 2024; Accepted: 29 Apr 2024.

    Copyright: © 2024 Barone, Foschi, Pavolucci, Rondelli, Rinaldi, Nicodemo, D'Angelo, Favaretto, Brusi, Cosmi, Degli Esposti, Sergio, Bacchelli, Giostra, Pomata, Spinardi, Faccioli, Faggioli, Donti, Borghi, Cortelli and Guarino. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Maria Guarino, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.