Research On Predictive Value Of ABCD~3L Score In Identifying Individuals At High Early Risk Of Stroke After Transient Ischemic Attack

Transient ischemic attack （TIA）is the early warning signal of ischemic stroke,including anterior-circulation (internal carotid artery) TIA and posterior-circulation(Vertebral basilar artery system) TIA. ABCD3score is widely used as a quantitativeindex of the TIA related risk assessment currently, but it can not predict all the strokeafter TIA. The low-density lipoprotein cholesterol (LDL-C) level of plasma is a majorrisk factor of atherosclerosis (AS). This study focused on whether the ABCD3scorecombined with LDL-C levels to assess the risk of stroke after TIA is better than thesimple application of ABCD3score, aiming to find an objective indicator of anaffordable, convenient and effective for the grass-roots hospitals and provide the basisfor clinical treatment of TIA.Objectives:The aim of this study was to campare the predictive value of ABCD3scorecombined with the level of LDL-C (ABCD3L Score) and ABCD3Score. And theresult provided a convenient and effective method to evaluate early stroke risk afterTIA for basic level hospital, facilitating the development of individualized secondaryprevention strategies. Methods:Data were prospectively collected from268patients from the NeurologyDepartment of the Sanmenxia Central Hospital from September2010to September2013, who had transient ischemic attack, as defined by the World Health Organizationtime-based criteria.2ml venous blood of all the patients was collected in the secondmorning to identify the level of LDL-C. ABCD3L and ABCD3scores were availablewithin7days of the index transient ischemic attack. The predictive outcome wasstroke occurrence at2and7days. The comparison of the area under the receiver-operating characteristic curve (area under the curve) was performed by Z test. Allpatients were performed by ABCD3L score and risk stratification: low risk group(0-3), medium risk group (4-6), high risk group (≥7),Incidences of cerebralinfarction after2days and7days were compared by chi square test to determinedifferences in risk stratification. All tests were two-tailed and interpreted at the5%level of significance.Results：268TIA patients were registered consecutively including159(59.3%) malecases and109(40.7%) female cases. Age ranged from29to82and average age was61.13±15.67. There were19(7.1%) patients who had ischemic stroke at2-day and28(10.4%) patients who had ischemic stroke at7-day. The risk of stroke was higheraccording to the increment of the score. AUROCC of ABCD3score was0.785（95%CI=0.675-0.892，P<0.001）、0.832（95%CI=0.751-0.913，P<0.001）after2days and7days,and AUROCC of ABCD3L score was0.852（95%CI=0.762-0.943，P<0.001）、0.879（95%CI=0.811-0.956，P<0.001）respectively. The ABCD3L scorearea under the curve of maximum system (P <0.001). Furthermore, according toABCD3L score, the risk of cerebral infarction within2days was of20.2%,1.6%,0%(P <0.001) respectively in high risk group (7-10), medium risk group (4-6) and lowrisk group (0-3),and it was27.4%,3.9%,0%(P <0.001) within7days. In addition,patients with an ABCD3L score of7to10were associated with a12-fold,7-fold greater risk of stroke than patients with0to6respectively within2and7days.Conclusion:The ABCD3score and the plasma LDL-C level can be combined to better assessthe risk of early stroke after transient ischemic attack.