PREDICTORS OF MAJOR VASCULAR EVENTS IN PATIENTS WITH A TRANSIENT ISCHEMIC ATTACK OR MINOR ISCHEMIC STROKE AND WITH NONRHEUMATIC ATRIAL-FIBRILLATION

Background and Purpose The risk of major vascular events after an init ial episode of cerebral ischemia in patients with nonrheumatic atrial fibrillation (NRAF) varies from 2% to 15% in the first year and is app roximately 5% yearly thereafter. Few studies have reported on risk fac tors that can be used to identify high-risk subgroups within this pati ent population. Methods We studied the predictive value of several eas ily obtainable clinical characteristics in a group of 375 placebo-trea ted patients with NRAF and a recent episode of transient or nondisabli ng cerebral ischemia who were entered in a multicenter clinical trial. The mean follow-up was 1.6 years. Results By means of multivariate mo deling, six independent variables were identified: history of previous thromboembolism, ischemic heart disease, enlarged cardiothoracic rati o on chest roentgenogram, systolic blood pressure greater than 160 mmH g at study entry, NRAF for more than 1 year, and presence of an ischem ic lesion on CT scan. These variables could also be used to stratify p atients in low-, medium-, and high-risk subgroups for the other two ar ms of the trial, those treated with anticoagulation and aspirin. Patie nts older than 75 years with three or more risk factors seemingly bene fited less from both aspirin and anticoagulant treatment. Conclusions Easily obtainable patient characteristics are helpful in estimating th e potential effect of adequate secondary prevention in patients with N RAF who recently suffered a transient ischemic attack or minor ischemi c stroke.