Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies

Background: Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta-analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke, defined as a...

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Autores: Lim, Andy, Ma, Henry, Johnston, S. Claiborne, Singhal, Shaloo, Muthusamy, Subramanian, Wang, Yongjun, Pan, Yuesong, Coutts, Shelagh B., Hill, Michael D., Ois Santiago, Angel Javier, Kapral, Moira K., Knoflach, Michael, Woodhouse, Lisa J., Bath, Philip M., Phan, Thanh G.
Tipo de documento: artigo
Estado:Versão publicada
Data de publicação:2024
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositório:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/70805
Acesso em linha:http://hdl.handle.net/10230/70805
http://dx.doi.org/10.1161/JAHA.123.032471
Access Level:Acceso aberto
Palavra-chave:Humans
Ischemic attack
Transient
Recurrence
Stroke
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spelling Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studiesLim, AndyMa, HenryJohnston, S. ClaiborneSinghal, ShalooMuthusamy, SubramanianWang, YongjunPan, YuesongCoutts, Shelagh B.Hill, Michael D.Ois Santiago, Angel JavierKapral, Moira K.Knoflach, MichaelWoodhouse, Lisa J.Bath, Philip M.Phan, Thanh G.HumansIschemic attackTransientRecurrenceStrokeBackground: Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta-analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke, defined as a National Institutes of Health Stroke Scale severity score of ≤5. Methods and results: Published papers found on PubMed from 2000 to January 12, 2021, reference lists of relevant articles, and experts in the field were involved in identifying relevant studies. Randomized controlled trials and observational studies describing minor stroke cohort with reported 90-day stroke recurrence were selected by 2 independent reviewers. Altogether 14 of 432 (3.2%) studies met inclusion criteria. Multilevel random-effects meta-analysis was performed. A total of 6 randomized controlled trials and 8 observational studies totaling 45 462 patients were included. The pooled 90-day stroke recurrence was 8.6% (95% CI, 6.5-10.7), reducing by 0.60% (95% CI, 0.09-1.1; P=0.02) with each subsequent year of publication. Recurrence was lowest in dual antiplatelet trial arms (6.3%, 95% CI, 4.5-8.0) when compared with non-dual antiplatelet trial arms (7.2%, 95% CI, 4.7-9.6) and observational studies 10.6% (95% CI, 7.0-14.2). Age, hypertension, diabetes, ischemic heart disease, or known atrial fibrillation had no significant association with outcome. Defining minor stroke with a lower National Institutes of Health Stroke Scale threshold made no difference - score ≤3: 8.6% (95% CI, 6.0-11.1), score ≤4: 8.4% (95% CI, 6.1-10.6), as did excluding studies with n<500%-7.3% (95% CI, 5.5-9.0). Conclusions: The risk of recurrence after minor ischemic stroke is declining over time but remains important.Wiley202520252024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/70805http://dx.doi.org/10.1161/JAHA.123.032471http://hdl.handle.net/10230/70805reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésJ Am Heart Assoc. 2024 May 7;13(9):e032471© 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:recercat.cat:10230/708052026-05-29T05:05:01Z
dc.title.none.fl_str_mv Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
title Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
spellingShingle Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
Lim, Andy
Humans
Ischemic attack
Transient
Recurrence
Stroke
title_short Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
title_full Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
title_fullStr Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
title_full_unstemmed Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
title_sort Ninety-day stroke recurrence in minor stroke: Systematic review and meta-analysis of trials and observational studies
dc.creator.none.fl_str_mv Lim, Andy
Ma, Henry
Johnston, S. Claiborne
Singhal, Shaloo
Muthusamy, Subramanian
Wang, Yongjun
Pan, Yuesong
Coutts, Shelagh B.
Hill, Michael D.
Ois Santiago, Angel Javier
Kapral, Moira K.
Knoflach, Michael
Woodhouse, Lisa J.
Bath, Philip M.
Phan, Thanh G.
author Lim, Andy
author_facet Lim, Andy
Ma, Henry
Johnston, S. Claiborne
Singhal, Shaloo
Muthusamy, Subramanian
Wang, Yongjun
Pan, Yuesong
Coutts, Shelagh B.
Hill, Michael D.
Ois Santiago, Angel Javier
Kapral, Moira K.
Knoflach, Michael
Woodhouse, Lisa J.
Bath, Philip M.
Phan, Thanh G.
author_role author
author2 Ma, Henry
Johnston, S. Claiborne
Singhal, Shaloo
Muthusamy, Subramanian
Wang, Yongjun
Pan, Yuesong
Coutts, Shelagh B.
Hill, Michael D.
Ois Santiago, Angel Javier
Kapral, Moira K.
Knoflach, Michael
Woodhouse, Lisa J.
Bath, Philip M.
Phan, Thanh G.
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Humans
Ischemic attack
Transient
Recurrence
Stroke
topic Humans
Ischemic attack
Transient
Recurrence
Stroke
description Background: Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta-analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90-day stroke recurrence for minor ischemic stroke, defined as a National Institutes of Health Stroke Scale severity score of ≤5. Methods and results: Published papers found on PubMed from 2000 to January 12, 2021, reference lists of relevant articles, and experts in the field were involved in identifying relevant studies. Randomized controlled trials and observational studies describing minor stroke cohort with reported 90-day stroke recurrence were selected by 2 independent reviewers. Altogether 14 of 432 (3.2%) studies met inclusion criteria. Multilevel random-effects meta-analysis was performed. A total of 6 randomized controlled trials and 8 observational studies totaling 45 462 patients were included. The pooled 90-day stroke recurrence was 8.6% (95% CI, 6.5-10.7), reducing by 0.60% (95% CI, 0.09-1.1; P=0.02) with each subsequent year of publication. Recurrence was lowest in dual antiplatelet trial arms (6.3%, 95% CI, 4.5-8.0) when compared with non-dual antiplatelet trial arms (7.2%, 95% CI, 4.7-9.6) and observational studies 10.6% (95% CI, 7.0-14.2). Age, hypertension, diabetes, ischemic heart disease, or known atrial fibrillation had no significant association with outcome. Defining minor stroke with a lower National Institutes of Health Stroke Scale threshold made no difference - score ≤3: 8.6% (95% CI, 6.0-11.1), score ≤4: 8.4% (95% CI, 6.1-10.6), as did excluding studies with n<500%-7.3% (95% CI, 5.5-9.0). Conclusions: The risk of recurrence after minor ischemic stroke is declining over time but remains important.
publishDate 2024
dc.date.none.fl_str_mv 2024
2025
2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/70805
http://dx.doi.org/10.1161/JAHA.123.032471
http://hdl.handle.net/10230/70805
url http://hdl.handle.net/10230/70805
http://dx.doi.org/10.1161/JAHA.123.032471
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv J Am Heart Assoc. 2024 May 7;13(9):e032471
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Wiley
publisher.none.fl_str_mv Wiley
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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