Abstract DP010: Predictors of Major Adverse Cardiovascular Events After Transient Ischemic Attack: A Multi-State Analysis

Background: Patients with transient ischemic attack (TIA) are at high risk of subsequent vascular complications, yet large-scale, population-based analyses of risk factors for major adverse cardiovascular events (MACE) are limited. We evaluated demographic and clinical factors associated with MACE and other vascular outcomes within 1 year after TIA. Methods: We identified adult TIA survivors (≥18 years) discharged alive from statewide inpatient and emergency department databases of Florida, New York, Maryland, Washington, and Georgia (2016–2019). Multivariable Cox proportional hazards models were fit to evaluate factors associated with experiencing MACE (a composite of ICH, AIS, AMI, and vascular death) within one year. Fine–Gray sub-distribution hazards models, with death as a competing risk, were used to assess predictors of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and acute myocardial infarction (AMI) risk. Adjusted hazard ratios (aHR), sub-distribution hazard ratios (aSHR), and 95% CIs are reported. Results: Among 103,050 TIA survivors (median age [IQR]: 70 [59–80] years; 56.2% female), 4.7% experienced MACE within 1 year, and 3.2%, 0.2%, and 0.9% experienced AIS, ICH, and AMI, respectively. Older age (aHR, 95% CI: 1.01, 1.01–1.02), non-Hispanic Black (NHB) race (1.25, 1.15–1.35 vs Non-Hispanic White), residence in small metro areas (1.08, 1.01–1.16) or non-metro areas (1.47, 1.34–1.62) (vs. large metro), hypertension (1.25, 1.15–1.35), diabetes (1.30, 1.22–1.39), atrial fibrillation (1.18, 1.09–1.29), smoking (1.17, 1.10–1.24), and higher Charlson comorbidity index (1.09, 1.08–1.11) were associated with a higher risk of MACE. Conversely, private insurance (0.77, 0.69–0.85 vs. Medicare), female sex (0.81, 0.76–0.85), and higher neighborhood income (Q3 vs Q1: 0.89, 0.82–0.97; Q4 vs Q1: 0.76, 0.69–0.84) were associated with lower risk of MACE. Similar patterns were observed for AIS (aSHR: NHB, 1.34; diabetes, 1.38; hypertension, 1.31) and AMI (aSHR: diabetes, 1.50; hypertension, 1.34; hyperlipidemia, 1.20). Conclusions: Patients with TIA face a considerable risk of recurrent vascular events, driven by modifiable cardiovascular factors and marked by significant racial, insurance, and socioeconomic disparities. Aggressive risk factor modification and targeted interventions addressing healthcare inequities are essential to reduce the risk of post-TIA vascular events.