| Objective: Patients with transient ischemic attack (TIA) are at high risk of early cerebral infarction.How to predict who is at the highest early risk of cerebral infarction is the key point.The"ABCD2"tool of Johnston's was proposed as a method to triage these patients using five clinical factors in 2007. The addition of magnetic resonance imaging (MRI) in Coutts's study significantly improved the predictive accuracy of the original"ABCD2"tool in 2008. The study of the clinical usefulness of the"ABCD2"model in our state is very few. It is unclear the value of MRI factors of the brain will add to the prediction rule. The present study evaluate the adding value of diffusion-weighted-Imaging(DWI) and magnetic resonance angiography (MRA)to the"ABCD2"clinical scale. The purpose of this study to investigate the risk factors influencing TIA to evolve into cerebral infarction within 2-day to 30-day and to aid the clinician in the risk stratification of patients with TIA.Methods: The clinical data ,DWI and MRA findings of hospitalized TIA patients were analyzed in department of neurology of second hospital of HeBei medical university from January 2009 to December 2009. The"ABCD2"score was applied to all the patients and uesd to analysis the 2-day to 30-day risk of cerebral infarction. The characteristics of the event were recorded in cases of first-ever probable or definite TIA. In patients with more than one TIA in the past time, the duration of the longest event was used.The correlation between"ABCD2"score and short-term risk of cerebral infarction in TIA patients was analyzed by linear regression analysis.The predictive accuracy of the score was quantified by the area under the curve (AUC) of receiver operator characteristic(ROC) curve .Risk factors were compared in different score,DWI and MRA byχ2 test.The"ABCD2"score risk factors of the short-time prognosis were analyzed byχ2 test . Results: (1) 116 of 182 cases were males(63.7%) and 66 were females(36.3%). Age ranged from 17 to 88 years old. The mean age was (58.52±13.05) years old.56.6% patients were internal carotid artery(ICA) TIA,28.0% were vertebrobasilar artery(VBA)TIA,15.4% were unclear classify between ICA and VBA.A history of 10 patients had stroke ,86 patients had hypertension ,38 patients had diabetes and 9 had ischemic heart disease.53 cases had DWI test,39.6% had DWI lesion.120 patients had MRA test,44.2% were intracranial artery stenosis<50% ,35.8% were intracranial artery stenosis( 50% to 75%),20% were intracranial artery stenosis>75%.A total of 56(30.8%) patients had cerebral infarction within 30 days after symptoms ,while 42(23.1%) patients occurred within 7 days,19(10.4 %) occurred within 2 days.(2) Linear correlation existed between ABCD2 score and short-term risk of cerebral infarction in TIA patients(P<0.05). The higher the score was, the higher the incidence was . The AUC of"ABCD2"score for 2-day,7-day and 30-day are 0.836,0.806,0.806,respectively,P<0.05.The score of 3 is the best cut-off.(3) The incidences of cerebral infarction were significantly higher in the patients with DWI lesions in 2-day ,7-day and 30-day and intracal arterial stenosis≥50%in 30-day(P<0.05).(4) The incidence was significantly higher in TIA patients older than 60 years and the symptoms lasting over 10 minutes in 2-day risk of cerebral infarction (P<0.05).The incidence was significantly higher in TIA patients older than 60 years,the symptoms lasting over 10 minutes and diabetes mellitus in 7-day risk of cerebral infarction (P<0.05).The incidence was significantly higher in TIA patients older than 60 years and unilateral weakness in 30-day risk of cerebral infarction(P<0.05).Conclusions: The ABCD2 score is effective to predict risk of cerebral infarction in the patients with TIA in 2-day to 30-day. It can aid the clinician in the management of patients with TIA .Combination with the DWI and MRA findings can improve the predictive accuracy of cerebral infarction after TIA.
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