Stroke: 10-year follow-up: What is the long-term significance of emergency secondary prevention after transient ischemic attack and minor stroke

There are now some treatments to prevent transient ischemic attack (TIA) and recurrent strokes after minor strokes
.

These interventions can reduce the short-term risk of recurrent stroke by 90%

Prevention of stroke diagnosis

In the past, in countries such as the United Kingdom, most TIAs and minor strokes were evaluated for the first time in primary medical institutions, and patients faced a delay of ≈20 days between the occurrence of the incident and the prescription of treatment
.

The vast majority of TIA and minor strokes are evaluated for the first time in primary care institutions, and patients face a delay of ≈20 days between the occurrence of the event and the prescription of treatment
.

The EXPRESS study (early use of existing stroke prevention strategies) showed that by setting up an emergency outpatient TIA clinic, the delay between the occurrence of an event and the treatment prescription was reduced to 1 day, and the 90-day risk of recurrence stroke was reduced from 10 days to 20 days
.

In addition, EXPRESS shows that these emergency clinics have greatly reduced hospital care costs related to vascular events and disability 6 months after index events

Blood vessel

The SOS-TIA study (transient ischemic attack clinic visited around the clock) also achieved similar results
.

Although these studies are non-randomized, they are widely considered in clinical guidelines to provide high-quality evidence of the benefits of acute evaluation, and the substantial reduction in the risk of early stroke recurrence has been confirmed in randomized trials of acute antiplatelet therapy

manage

Although emergency TIA/minor stroke clinics have great benefits in the short-term, there is limited evidence that such acute preventive interventions have an impact on outcomes and costs in the long-term
.

In the CHANCE trial (clopidogrel in high-risk patients with acute non-disabling cerebrovascular events), the early benefit of dual antiplatelet therapy in reducing the risk of recurrent stroke still exists after 1 year, but there are no long-term data

Myocardial infarction

However, if early-stage high-risk patients still have a high risk of recurrence and stroke in the long-term, then any benefit of acute intervention may diminish over time, and the event is only delayed rather than completely prevented
.

Through the EXPRESS study, Ramon Luengo-Fernandez of Oxford University and others evaluated the short-term benefits of TIA/Mild Stroke Emergency Clinic in reducing the risk of recurrent stroke, reducing disability and hospital care costs over 10 years
.

The short-term benefits of TIA/Mild Stroke Emergency Clinic in reducing the risk of recurrent stroke, reducing disability and hospital care costs were evaluated over a 10-year period
.

EXPRESS is a population-based prospective study, before the study (Phase I: April 2002-September 2004; n=310) and after (Phase II: October 2004-March 2007; n =281) There are external controls for the effects of early evaluation and treatment of transient ischemic attack/minor stroke on the risk of early recurrent stroke
.

This report assesses the impact on the 10-year risk of recurrent stroke, functional outcomes, quality of life, and cost

The stroke risk reduction in the second stage is still significant at 10 years (55/23.

3% vs.
82/31.

The disability-free life expectancy of patients in the second stage is 0.
59 (0.
03-1.
15; P=0.
043) years higher, as is the life expectancy after quality adjustment (0.
49[0.
03-0.
95]; P=0.
036)
.

In general, the 10-year cost of patients participating in the Phase 2 clinic is not significantly high (US$1,022 [-3865-5907]; P=0.
66)
.

Compared with the first stage, the additional cost of each quality-adjusted life year for Phase 2 is US$2103, which is far below the current cost-effectiveness threshold
.

Urgent assessment and treatment of patients with transient ischemic attack or minor stroke can reduce recurrent strokes and improve prognosis in the long term.
Over time, the early benefits hardly atrophy, even within a 10-year time frame.
Value for money
.
The results indicate that other effective acute treatments for transient ischemic attacks/minor strokes in the short term may also have long-term benefits
.

Original Source:
Luengo-Fernandez R, Li L, Silver L, Gutnikov S, Beddows NC, Rothwell PM.
Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study.
  Stroke.
Published online October 28, 2021:STROKEAHA.
121.
034279.
doi:10.
1161/STROKEAHA.
121.
034279

Other effective acute treatments for transient ischemic attacks/minor strokes in the short term may also have long-term benefits
.
Long-Term Impact of Urgent Secondary Prevention After Transient Ischemic Attack and Minor Stroke: Ten-Year Follow-Up of the EXPRESS Study.
 

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