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Review
. 2011 Sep 27;77(13):1222-8.
doi: 10.1212/WNL.0b013e3182309f91. Epub 2011 Aug 24.

Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study

M F Giles  1 , G W Albers, P Amarenco, E M Arsava, A W Asimos, H Ay, D Calvet, S B Coutts, B L Cucchiara, A M Demchuk, S C Johnston, P J Kelly, A S Kim, J Labreuche, P C Lavallee, J-L Mas, A Merwick, J M Olivot, F Purroy, W D Rosamond, R Sciolla, P M Rothwell
Affiliations
Review

Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study

M F Giles et al. Neurology. .

Abstract

Objectives: Stroke risk immediately after TIA defined by time-based criteria is high, and prognostic scores (ABCD2 and ABCD3-I) have been developed to assist management. The American Stroke Association has proposed changing the criteria for the distinction between TIA and stroke from time-based to tissue-based. Research using these definitions is lacking. In a multicenter observational cohort study, we have investigated prognosis and performance of the ABCD2 score in TIA, subcategorized as tissue-positive or tissue-negative on diffusion-weighted imaging (DWI) or CT imaging according to the newly proposed criteria.

Methods: Twelve centers provided data on ABCD2 scores, DWI or CT brain imaging, and follow-up in cohorts of patients with TIA diagnosed by time-based criteria. Stroke rates at 7 and 90 days were studied in relation to tissue-positive or tissue-negative subcategorization, according to the presence or absence of brain infarction. The predictive power of the ABCD2 score was determined using area under receiver operator characteristic curve (AUC) analyses.

Results: A total of 4,574 patients were included. Among DWI patients (n = 3,206), recurrent stroke rates at 7 days were 7.1%(95% confidence interval 5.5-9.1) after tissue-positive and 0.4% (0.2-0.7) after tissue-negative events (p diff < 0.0001). Corresponding rates in CT-imaged patients were 12.8% (9.3-17.4) and 3.0% (2.0-4.2), respectively (p diff < 0.0001). The ABCD2 score had predictive value in tissue-positive and tissue-negative events (AUC = 0.68 [95% confidence interval 0.63-0.73] and 0.73 [0.67-0.80], respectively; p sig < 0.0001 for both results, p diff = 0.17). Tissue-positive events with low ABCD2 scores and tissue-negative events with high ABCD2 scores had similar stroke risks, especially after a 90-day follow-up.

Conclusions: Our findings support the concept of a tissue-based definition of TIA and stroke, at least on prognostic grounds.

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Figures

Figure
Figure. Pooled analysis of association between ABCD2 score and presence of infarction on diffusion-weighted imaging (DWI) or CT brain imaging
Odds ratios are relative to an ABCD2 score of ≤1.
See this image and copyright information in PMC

Comment in

References

    1. Giles MF, Rothwell PM. Risk of stroke early after transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2007;6:1063–1072 - PubMed
    1. Wu CM, McLaughlin K, Lorenzetti DL, et al. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med 2007;167:2417–2422 - PubMed
    1. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–292 - PubMed
    1. Department of Health National Stroke Strategy. London: Crown; 2007
    1. National Stroke Foundation Clinical Guidelines for Acute Stroke Management [online]. Melbourne, Australia: National Stroke Foundation; 2007. Available at: www.strokefoundation.com.au Accessed September 14, 2010

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