Risk of Major Adverse Cardiovascular Events After Retinal Vascular Occlusions Versus Transient Ischemic Attack: A Propensity-Score Matched Cohort Study.

BACKGROUND: Retinal vascular occlusions (RVaO) are signs of systemic vascular disease and share risk factors with stroke and myocardial infarction. The cardiovascular risk of RVaO subtypes and their relationship to transient ischemic attack (TIA) remain unclear. METHODS: Using the TriNetX database, we compared the 1-year incidence of major adverse cardiovascular events (MACE), including ischemic and hemorrhagic stroke, acute myocardial infarction, and death, between patients with RVaO and those with TIA. Cox regression was used to analyze the association between risk factors and MACE risk. RESULTS: We identified 91 936 patients with RVaO and 392 069 patients with TIA. After propensity score matching, each cohort included 90 698 patients. The RVaO cohort had a significantly lower 1-year MACE risk than the TIA cohort (hazard ratio [HR], 0.77 [95% CI, 0.74-0.80]), with reduced risks of ischemic stroke (HR, 0.64 [95% CI, 0.60-0.67]), hemorrhagic stroke (HR, 0.82 [95% CI, 0.71-0.94]), and acute myocardial infarction (HR, 0.89 [95% CI, 0.83-0.96]). All-cause mortality was similar. Subtype-specific analysis showed that patients with central retinal artery occlusion had higher risks of MACE (HR, 1.13 [95% CI, 1.02-1.24]) and all-cause mortality (HR, 1.23 [95% CI, 1.02-1.49]) than patients with TIA. Within RVaO, age, male sex, retinal artery occlusion, ischemic heart disease, chronic kidney disease, heart failure, and nicotine dependence were important predictors of MACE risk. CONCLUSIONS: Patients with RVaO have a lower 1-year MACE risk than TIA, but this varies by subtype. central retinal artery occlusion has a prognosis similar to TIA, requiring urgent assessment and prevention. These findings highlight the importance of multidisciplinary care in RVaO management.