Identification of clinical features of patients with minor stroke or transient ischemic attack (TIA) that predict risk for very early recurrence of stroke.

Recent trials of acute secondary prevention in patients with minor ischemic stroke or TIA have demonstrated high rates of early recurrence within days of the initial event. The identification of patients at high risk might guide focused management.

Using logistic regression applied to the data of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, we evaluated whether baseline clinical factors could predict outcome events occurring within 7 days of randomization.

In the POINT trial, 181 subjects had early recurrence of primary outcome events (predominantly ischemic stroke) within 7 days of trial entry, whereas only 100 outcome events occurred over the remainder of the 90 day trial. In univariate analysis, systolic blood pressure, diastolic blood pressure, serum glucose, initial carotid imaging results, study cohort (minor stroke or TIA), and treatment assignment (aspirin alone or aspirin plus clopidogrel) were significantly associated with early recurrence. A multivariate logistic regression model, incorporating predictors with significant association in univariate analysis, found that serum glucose, systolic blood pressure, cohort, and treatment were independently associated with early recurrence, with Receiver Operator Characteristic (ROC) analysis showing 69.7% accuracy of the model when applied to a separate validation subset. Using a cut-off odds ratio of 0.03, the model had a sensitivity of 83% and specificity of 44% for predicting early recurrence. Incorporating additional factors in the logistic regression model suggested that age, absence of statin usage, and significant stenosis on carotid imaging were also independently associated with early recurrence.

Baseline clinical factors, including serum glucose, systolic blood pressure, cohort, and treatment assignment, can provide modest accuracy in predicting early recurrence of stroke in the POINT trial population.