A Multicentre Prospective Cohort Study to Identify High-Risk Transient Ischemic Attack/Minor Stroke Patients Benefitting from Echocardiography.

Autor: Perry JJ; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: jperry@ohri.ca., Alsadoon A; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Founder SmartMed, SmartLab and Jiwar Freestanding ER, Saudi Arabia., Nemnom MJ; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Sivilotti MLA; Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada., Émond M; CHU de Québec, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada; Division of Emergency Medicine, Université Laval, Québec City, Québec, Canada., Stiell IG; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Stotts G; Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Lee JS; Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Worster A; McMaster University, Hamilton, Ontario, Canada., Morris J; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada., Cheung KW; University of British Columbia, Vancouver, British Columbia, Canada., Jin AY; Division of Neurology, Queen's University, Kingston, Ontario, Canada., Sahlas DJ; Population Health Research Institute and Division of Neurology, McMaster University, Hamilton, Ontario, Canada., Murray HE; Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada., Mackey A; CHU de Québec, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada; Division of Neurology, Laval University, Québec City, Québec, Canada., Verreault S; CHU de Québec, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada; Division of Neurology, Laval University, Québec City, Québec, Canada., Camden MC; CHU de Québec, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada; Division of Neurology, Laval University, Québec City, Québec, Canada., Yip S; Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada., Teal P; Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada., Gladstone DJ; Sunnybrook Research Institute and Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada., Boulos MI; Sunnybrook Research Institute and Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada., Chagnon N; Department of Emergency Medicine, Montfort Hospital and University of Ottawa, Ottawa, Ontario, Canada., Shouldice E; Queensway Carleton Hospital and University of Ottawa, Ottawa, Ontario, Canada., Atzema C; Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada., Slaoui T; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada., Teitelbaum J; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada., Giannakakis SM; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada., Thiruganasambandamoorthy V; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Dowlatshahi D; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada., Wells GA; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada., Sharma M; Population Health Research Institute and Division of Neurology, McMaster University, Hamilton, Ontario, Canada.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1016/j.cjca.2024.09.008
Abstrakt: Background: We aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography.
Methods: This multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings.
Results: In 7149 eligible patients, a clinically significant finding was found in 556 (7.8%). There were a further 2421 (33.9%) with potentially significant findings. History of heart failure (adjusted odds ratio [OR], 3.9) or coronary artery disease (OR, 2.7) were the factors most strongly associated with clinically significant echocardiogram findings, whereas young age, male sex, valvular heart disease, and infarct (any age) on neuroimaging were modestly associated (OR, 1.3-1.9). The model combining these predictors into a score (range: 0-15), had a C-statistic of 0.67 (95% confidence interval [CI], 0.65-0.70). A cut point of 6 points or more classified 6.6% of cases as high likelihood, defined as > 15% for clinically significant echocardiogram findings.
Conclusions: Echocardiography is a very useful test in the investigations of patients with TIA/minor stroke. We identified high-risk clinical features-combined to create a clinical decision rule-to identify which patients with TIA/minor stroke are likely to have clinically significant echocardiogram findings requiring an immediate change in management. These patients should have echocardiography prioritized, whereas others may continue to have echocardiography conducted in a less urgent fashion.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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