London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 725 719 Acute cerebrovascular events (ACE): TIA and minor strokes LONG TERM EVOLUTION OF PATIENTS TREATED IN A TIA UNIT L. Benavente1, S. Calleja2, J. Vega3, D. Larrosa4, M. Rico5, M. Para6, J. Pascual7 Hospital Universitario Central de Asturias, Oviedo, SPAIN1, Hospital Universitario Central de Asturias, Oviedo, SPAIN2, Hospital Universitario Central de Asturias, Oviedo, SPAIN3, Hospi-tal Universitario Central de Asturias, Oviedo, SPAIN4, Hospital Universitario Central de Asturias, Oviedo, SPAIN5, Hospital Universitario Central de Asturias, Oviedo, SPAIN6, Hospital Universitario Central de Asturias, Oviedo, SPAIN7 BACKGROUND. Transient ischemic attacks (TIA) entail a high risk of stroke recurrence, which depends on the etiology. New organizational models have been created, but there is not much infor-mation about the long-term evolution of patients managed according to these premises. Our aim is to refer the follow-up of patients attended according to our model of TIA Unit. METHODS. TIA Unit is located in the Emergency Department and staffed by vascular neurologists. Patients admitted during the Neurology night shift stayed in such Unit <48h with complete etiolog-ical study. Preventive treatment is instituted in patients discharged to a high resolution Neurology consult, in order to review in <2 weeks and subsequent follow-up. RESULTS. During a year 161 patients were attended, being admitted to the hospital 8.6%. A to-tal of 1470 hospital days were avoided. Recurrence at 90 days was of 0.6%. Mean follow-up was 18.14±8.02 months (0-34), total recurrence 6.2% (70% cardioembolic strokes). There were no com-plications derived from treatment. Cardiological events were recorded in 10.6%, neoplastic in 5%, cognitive impairment in 11%. There were 3 deaths unrelated nor to the stroke or its treatment. CONCLUSIONS. This model allows an early diagnosis and treatment of TIA, preventing recurrenc-es of stroke in a long term. It detects atherothrombotic strokes, most of them admitted to the hospi-tal, and it shows a greater difficulty for detecting all cardioembolic strokes. TIA Unit appeared to be safe in using anticoagulation therapy, as the follow-up shows. It shows the same quality of manage-ment than hospital admission, with a significant saving in hospital stays. 720 Acute cerebrovascular events (ACE): TIA and minor strokes Why do patients with TIA have higher risk of early stroke recurrence than those with isch-aemic stroke? Influence of patient behavior and other risk factors in the North Dublin Popula-tion Stroke Study L. Akijian1, D. Ní Chróinín2, N. Hannon3, E.L. Callaly4, M. Marnane5, Á. Merwick6, Ó. Sheehan7, G. Horgan8, J. Duggan9, L. Kyne10, J. Moroney11, S. Murphy12, E. Dolan13, D. Williams14, P.J. Kelly15 The Mater Misericordiae University Hospital, Dublin, IRELAND1, The Mater Misericordiae University Hospital, Dublin, IRELAND2, The Mater Misericordiae University Hospital, Dublin, IRELAND3, The Mater Misericordiae University Hospital, Dublin, IRELAND4, The Mater Miseri-cordiae University Hospital, Dublin, IRELAND5, The Mater Misericordiae University Hospital, Dublin, IRELAND6, The Mater Misericordiae University Hospital, Dublin, IRELAND7, The Mater Misericordiae University Hospital, Dublin, IRELAND8, The Mater Misericordiae University Hospi-tal, Dublin, IRELAND9,The Mater Misericordiae University Hospital, Dublin, IRELAND10, Beau-mont Hospital, Dublin, IRELAND11, The Mater Misericordiae University Hospital, Dublin, IRE-LAND12, The Mater Misericordiae University Hospital, Dublin, IRELAND13, Beaumont Hospital, Dublin, IRELAND14, The Mater Misericordiae University Hospital, Dublin, IRELAND15 Background: Early recurrent stroke is a major cause of disability after first ischaemic stroke and TIA, but factors underlying early recurrence risk are not well-understood. We aimed to investigate risk factors for re-current stroke after first stroke and TIA in a population-based cohort study. Methods: The North Dublin Population Stroke Study applied multiple overlapping (‘gold-standard’) methods, to ascertain hospital- and community-treated stroke and TIA patients in a 12-month period. Inclu-sion criteria for this analysis were: (1) Stroke-physician confirmed TIA/ischaemic stroke; (2) First occurrence of new stroke/TIA (first-ever and prevalent) events within the ascertainment period. Ear-ly recurrent stroke was confirmed by a stroke physician. Results: 584 patients met inclusion criteria (172 TIA, 412 stroke). Preventive medication use and stroke risk factors were similar, except atrial fibrillation (more frequent in stroke than TIA, 36.7 versus 27.7%, p=0.04). Recurrent stroke rates were: 4.1% (TIA) vs 1.23% (stroke) (at 72 hours, p=0.03); 13.5% (TIA) vs 5.7% (stroke) (at 90 days, p=0.002). Fewer TIA than stroke patients presented to medical attention after first symptoms (p=0.005). More TIA patients presented with recurrent stroke (8.2% vs 0.2%, p=0.005). Recurrent stroke was more likely in patients with TIA at all follow-up intervals (7day OR 2.7, p=0.03). Delay >72 hours in seeking first medical attention (OR 3.1, p=0.002) and carotid stenosis/ occlusion (OR 2.5, p=0.008) were associated with stroke recurrence at 90 days. On multivariable analysis, TIA (p=0.02), delay in seeking attention (OR 2.3, p=0.06), and carotid disease (OR 2.3, p=0.03) were independent predictors of 90-day recurrent stroke. Conclusion: Our population-based data suggest that combined patient behaviour and pathophysiological fac-tors are associated with early stroke recurrence risk. Improved public awareness to reduce delays to seeking treatment for TIA symptoms is needed.
Karger_ESC London_2013
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