| Part 1 Predictive Ability of ABCD-Serial Scores for Early Stroke Risk after Transient Ischemic AttackBackground and Purpose:Patients with transient ischemic attack (TIA) are at high risk of early subsequent stroke, with stroke rates ranging between 6.8%-11.5% by 90 days. The ABCD-serial scores have been developed to identifying high risk subgroup patients and may be helpful to implement urgent and aggressive treatment. The ABCD and ABCD2 score were used to triage patients in primary care for admission and further treatment. In 2010, Merwick at el proposed the ABCD3-I score to further classify the stroke risk for secondary care. The aim of this study was to explore the ability of different ABCD serial scores in predicting stroke risk after TIA onset.Methods:Consecutive patients with clinically defined TIA were enrolled and assessed. The values of different ABCD scores were calculated for each patient. The predictive ability of the ABCD, ABCD2, ABCD3 and ABCD3-I score were evaluated by means of receiver operating characteristic curve and compared using Delong’s method.Results:A total of 658 patients were included in the study, of which 70 (10.6%) patients experienced subsequent stroke by 90 days. The mean age was 62.0±12.5, of whom 176 (26.7%) patients were women. Dual TIA, carotid stenosis and positive diffusion-weighted imaging (DWI) were found in 246 (37.4%),119 (18.1%) and 236 (35.9%) patients, respectively. The C statistic for 90-day stroke occurrence was 0.622 (0.549-0.695) with ABCD,0.630 (0.560-0.700) with ABCD2,0.639 (0.572-0.706) with ABCD3,0.693 (0.634-0.753) with ABCD2-I, and 0.729 (0.677-0.782) with ABCD3-I, respectively. Compared with ABCD2, the ABCD3-I score showed greater discriminative ability (C statistic,0.639 vs 0.729, P=0.002). However, the ABCD2-I and ABCD3-I score showed similar predictive ability (0.693 vs 0.729, P=0.138).Conclusions:The ABCD3-I score was superior to ABCD2 score in predicting early stroke event in patients with TIA.Part 2 The New ABCD3-I Scores Predict Early Subsequent Stroke in Patients with Transient Ischemic AttackBackground and Purpose:The ABCD3-I score was developed to predict early stroke risk after transient ischemic attack in 2010. By adding three more components, the ABCD3-I score showed greater predictive ability than ABCD2 score. Dual clinical transient ischemic attacks (dual TIA), defined as multiple TIAs within 7 days, is a component of the ABCD3-I score. We aimed to investigate whether dual tissue-defined ischemic attacks, defined as multiple diffusion-weighted imaging lesions of different age and/or arterial territory (dual DWI), is an independent and stronger predictor of 90-day stroke than dual TIA.Methods:Consecutive patients with clinically defined TIA were enrolled and assessed clinically and by MRI within three days. The predictive ability of the ABCD clinical factors, dual TIA and dual DWI were evaluated by means of multivariate logistic regression. The predictive ability of different scores were evaluated by means of receiver operating characteristic curve and compared using Delong’s method. The risk reclassification in comparison with the ABCD3-I score was calculated by categorized and continuous net reclassification improvement (NRI).Results:Among 658 patients who were included in the study and completed 90 days follow-up, a total of 70 (10.6%) patients experienced subsequent stroke by 90 days. Multivariate logistic regression indicated that dual DWI was an independent predictor for subsequent stroke [OR 4.64,95% confidence interval (CI) 2.15-10.01], while dual TIA was not (OR 1.18,95% CI 0.69-2.01). C statistics was higher when the item of dual TIA in ABCD3-I score was replaced by dual DWI (0.759 vs 0.729, p=0.035). The net reclassification value for 90-day stroke risk was also improved (continuous NRI 0.301, P=0.017).Conclusion:Dual DWI independently predicted future stroke in TIA patients. A new ABCD3-I score with dual DWI instead of dual clinical TIA may improve risk stratification for early stroke risk after TIA. |
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