PREDICTIVE VALUE OF CLINICAL HISTORY AND ELECTROCARDIOGRAM IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACK OR MINOR ISCHEMIC STROKE FOR SUBSEQUENT CARDIAC AND CEREBRAL ISCHEMIC EVENTS

Objective: Patients with cerebral ischemia have a high mortality rate. The most common cause of death is myocardial infarction. We attempted to identify risk factors for subsequent cardiac events in patients wi th cerebral ischemia by means of the history and electrocardiography p erformed with the patient at rest. Design: The original inception coho rt was entered in a multicenter randomized clinical trial (30 or 283 m g/d of aspirin) and followed up prospectively for a mean period of 2.6 years. Setting: Patients were admitted to the hospital or seen in out patient clinics.Patients: Patients with one or more transient ischemic attacks (symptoms completely reversible within 24 hours) and patients with minor ischemic stroke (symptoms persisting for longer than 24 ho urs) were randomized, provided they were independent in most activitie s of daily living. Patients with a definite or probable source of embo lism in the heart were excluded. A total of 3021 patients were include d in the study. Follow-up was performed at 4-month intervals. Main Out come Measures: Primary cardiac outcome events were defined as nonfatal myocardial infarction and cardiac death. Cardiac death included sudde n death, fatal myocardial infarction, or death due to congestive heart failure; 189 patients suffered a cardiac death-82 of which were sudde n deaths-or nonfatal myocardial infarction. Results: By means of multi variate analysis, the following independent predictors for cardiac eve nts were identified (hazards ratio/95% confidence limits): age older t han 65 years (1.6/1.2 to 2.2), male sex (1.5/1.1 to 2.1), angina pecto ris (1.5/1.0 to 2.3), diabetes (1.6/1.1 to 2.5), anterior infarction n oted on electrocardiography (1.7/1.1 to 2.7), inverted T wave noted on the electrocardiogram (1.6/1.1 to 2.4), and left ventricular hypertro phy noted on electrocardiography (3.2/2.0 to 4.9). Conclusions: The hi story and the electrocardiogram obtained with the patient at rest are valuable tools for cardiac risk assessment in patients with recent cer ebral ischemia.