Stroke Risk after Ischemic Ocular Events: Insights from an Electronic Health Record Database

Summary

Acute ischemic ocular events (RAO, amaurosis) increased risk for ischemic stroke-TIA, especially within 30 days. EMR database.

Abstract

Purpose: Acute ischemic ocular events (IOEs), including retinal artery occlusion and amaurosis fugax, pose a significant risk for impending ischemic stroke (IS) or transient ischemic attack (TIA). The objective is to investigate clinical characteristics that impact IS/TIA risk after the first retinal artery occlusion or amaurosis fugax among adults.

Design: Case-control study.

Subjects: The Truveta Electronic Health Record database was used to identify patients with incident IOE diagnosed between January 1, 2019, and September 30, 2024.

Methods: Logistic regression was applied to estimate odds ratios (ORs) for potential risk factors, including baseline demographics and comorbidities at or before the IOE.

Main outcomes: The occurrence of a stroke (IS or TIA) within 1 year after the IOE.

Results: Of 11 297 individuals with an IOE (mean age, 69.7 ± 12.8 years; 53.7% female), 1548 (13.5%) had an IS, 1231 had a TIA (10.9%), and 22.8% experienced either IS or TIA, or both (IS/TIA). Ischemic stroke/TIA occurred on the same day as the IOE in 9.4% of individuals. Older age (OR every 10 years, 1.11; 95% confidence interval [CI], 1.00-1.11), hypertension (OR, 1.19; 95% CI, 1.06-1.32), cardiovascular disease without history of myocardial infarction (OR, 1.89; 95% CI, 1.62-2.22), and carotid artery stenosis (CAS; OR, 1.60; 95% CI, 1.42-1.80) were associated with an increased risk of IS/TIA. In the IS cohort, older age (OR every 10 years, 1.11; 95% CI, 1.00-1.22), CAS (OR, 1.75; 95% CI, 1.52-2.02), and hypertension (OR, 1.36; 95% CI, 1.18-1.58) were also associated with increased risk, along with ischemic heart disease (OR, 1.23; 95% CI, 1.08-1.40) and peripheral vascular disease (OR, 1.18; 95% CI. 1.02-1.37). In the TIA cohort, older age (OR every 10 years, 1.11; 95% CI, 1.11-1.22), cardiovascular disease without a history of myocardial infarction (OR, 4.88; 95% CI, 3.57-6.87), and CAS (OR, 1.46; 95% CI, 1.24-1.71) were associated with greater risk.

Conclusion: Patients with IOEs are at significant risk for IS/TIA, with a high rate of diagnosis within 30 days after the IOE. Older age, underlying cardiovascular disease, CAS, and hypertension notably increased vulnerability to events. This highlights the need for not only immediate workup but also close follow-up of those with IOEs, especially with these risk factors.