Patients who underwent TIA have increased risk of subsequent stroke in the long-term, unravels study

A new study published in the Journal of American Medical Association showed that patients who have experienced a transient ischemic attack (TIA) or a mild stroke are at an increased risk of having another stroke.

The risk of ischemic stroke during the first 3 months after a TIA is not trivial, with reported rates ranging from 3% to 20%. However, the long-term incidence of ischemic stroke following TIA is unknown and warrants more investigation since it informs risk categorization, preventative interventions, and future studies. Thus, this study was done to evaluate the yearly and cumulative incidence rates of stroke up to 10 years following a TIA or mild stroke.

Embase, MEDLINE, and Web of Science were searched from inception to June 26, 2024. This study looked at prospective or retrospective cohort studies that reported stroke risk in individuals with TIA or mild stroke over a minimum of one year. The included studies provided unpublished aggregate-level data on the number of incidents and person-years at discrete follow-up periods, which were used to compute incidence rates in individual research. Data from many research projects were merged using random-effects meta-analysis. The main consequence was a stroke. Study-level factors were studied as possible reasons for variation in stroke rates among studies.

Of the 38 included studies, the analysis comprised 1,71,068 patients with a median age of 69 years [IQR, 65-71] and a median percentage of male patients of 57%. In the first year, there were 5.94 stroke events per 100 person-years, while in the second through fifth years, there were 1.80 occurrences per year and in the sixth through tenth years, there were 1.72 events per year. Stroke cumulative incidence was 12.5% at 5 years and 19.8% at 10 years.

Studies that employed active vs passive outcome ascertainment approaches, cohorts recruited in or after 2007, and studies done in North America and Asia as opposed to Europe had a greater incidence of stroke. Stroke rates were lower in research with an unselected patient sample than in studies that only included patients with TIA or first-ever index events. Overall, the risk of having another stroke is consistently elevated in patients who have experienced a TIA or small stroke. 

Source:

Writing Committee for the PERSIST Collaborators, Khan, F., Yogendrakumar, V., Lun, R., Ganesh, A., Barber, P. A., Lioutas, V.-A., Vinding, N. E., Algra, A., Weimar, C., Ögren, J., Edwards, J. D., Swartz, R. H., Ois, A., Giralt-Steinhauer, E., Khanevski, A. N., Leng, X., Tian, X., Leung, T. W., … Hill, M. D. (2025). Long-term risk of stroke after transient ischemic attack or minor stroke: A systematic review and meta-analysis. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2025.2033