Predictors of major vascular events in patients with a transient ischemic attack or nondisabling stroke

Background and Purpose: Very few studies have addressed the identification of prognostic factors in patients with a transient ischemic attack or minor stroke. Methods: We prospectively studied the prognostic value of clinical, laboratory, radiological, and electrocardiographic findings in 997 patients with a transient ischemie attack and 2,130 patients with a minor stroke who were entered into a multicenter clinical trial. The mean follow-up period was 2.6 years. Results: A total of 302 patients died (212 from a vascular cause), 272 had a stroke, and 200 had a cardiac event. By means of a multivariate analysis we identified the following independent risk factors for stroke, myocardial infarction, or vascular death: Age of >65 years; male sex; dysarthria; multiple attacks; diabetes; angina pectoris; intermittent claudication; computed tomographic evidence of any cerebral infarct, especially a border zone infarct or white matter hypodensity; and electrocardiographic evidence of an anteroseptal infarct, ST depression, left ventricular hypertrophy, or left atrial conduction delay. Protective predictors were monocular attacks only or the presence of rotatory dizziness. Conclusion: A limited number of easily obtainable characteristics are powerful predictors of major vascular events in patients with cerebral ischemia.