• Francisco Purroy, Pedro Enrique Jiménez Caballero, Arantza Gorospe, María José Torres, José Alvarez-Sabin, Estevo Santamarina, Patricia Martínez-Sánchez, David Cánovas, María José Freijo, Jose Antonio Egido, Jose M Ramírez-Moreno, Arantza Alonso-Arias, Ana Rodríguez-Campello, Ignacio Casado, Raquel Delgado-Mederos, Joan Martí-Fàbregas, Blanca Fuentes, Yolanda Silva, Helena Quesada, Pere Cardona, Ana Morales, Natalia Pérez de la Ossa, Antonio García-Pastor, Juan F Arenillas, Tomas Segura, Carmen Jiménez, Jaime Masjuán, and Stroke Project of the Spanish Cerebrovascular Diseases Study Group.
• Stroke Unit, Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de, Lleida, IRBLleida, Avda Rovira Roure, 80, Lleida 25198, Spain. fpurroygarcia@gmail.com
• J. Neurol. Neurosurg. Psychiatr.. 2013 Jun 1;84(6):596-603.

BackgroundMany guidelines recommend urgent intervention for patients with two or more transient ischaemic attacks (TIAs) within 7 days (multiple TIAs) to reduce the early risk of stroke.ObjectiveTo determine whether all patients with multiple TIAs have the same high early risk of stroke.MethodsBetween April 2008 and December 2009, we included 1255 consecutive patients with a TIA from 30 Spanish stroke centres (PROMAPA study). We prospectively recorded clinical characteristics. We also determined the short-term risk of stroke (at 7 and 90 days). Aetiology was categorised using the TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification.ResultsClinical variables and extracranial vascular imaging were available and assessed in 1137/1255 (90.6%) patients. 7-Day and 90-day stroke risk were 2.6% and 3.8%, respectively. Large-artery atherosclerosis (LAA) was confirmed in 190 (16.7%) patients. Multiple TIAs were seen in 274 (24.1%) patients. Duration <1 h (OR=2.97, 95% CI 2.20 to 4.01, p<0.001), LAA (OR=1.92, 95% CI 1.35 to 2.72, p<0.001) and motor weakness (OR=1.37, 95% CI 1.03 to 1.81, p=0.031) were independent predictors of multiple TIAs. The subsequent risk of stroke in these patients at 7 and 90 days was significantly higher than the risk after a single TIA (5.9% vs 1.5%, p<0.001 and 6.8% vs 3.0%, respectively). In the logistic regression model, among patients with multiple TIAs, no variables remained as independent predictors of stroke recurrence.ConclusionsAccording to our results, multiple TIAs within 7 days are associated with a greater subsequent risk of stroke than after a single TIA. Nevertheless, we found no independent predictor of stroke recurrence among these patients.

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