ABCD3 and ABCD3-I Scores Are Superior to ABCD2 Score in the Prediction of Short- and Long-Term Risks of Stroke After Transient Ischemic Attack

Abstract

Background and Purpose-Several risk scores have been developed to predict the stroke risk after transient ischemic attack (TIA). However, the validation of these scores in different cohorts is still limited. The objective of this study was to elucidate whether these scores were able to predict short-term and long-term risks of stroke in patients with TIA. Methods-From the Fukuoka Stroke Registry, 693 patients with TIA were followed up for 3 years. Multivariable-adjusted Cox proportional hazards model was used to assess the hazard ratio of risk factors for stroke. The discriminatory ability of each risk score for incident stroke was estimated by using C-statistics and continuous net reclassification improvement. Results-The multivariable-adjusted Cox proportional hazards model revealed that dual TIA and carotid stenosis were both significant predictors for stroke after TIA, whereas abnormal diffusion-weighted image was not. ABCD3 (C-statistics 0.61) and ABCD3-I (C-statistics 0.66) scores improved the short-term predictive ability for stroke (at 7 days) compared with the ABCD2 score (C-statistics 0.54). Addition of intracranial arterial stenosis (at 3 years, continuous net reclassification improvement 30.5%; P<0.01) and exclusion of abnormal diffusion-weighted imaging (at 3 years, continuous net reclassification improvement 24.0%; P<0.05) further improved the predictive ability for stroke risk until 3 years after TIA. Conclusions-The present study demonstrates that ABCD3 and ABCD3-I scores are superior to the ABCD2 score for the prediction of subsequent stroke in patients with TIA. Addition of neuroimaging in the ABCD3 score may enable prediction of long-term stroke risk after TIA. (Stroke. 2014;45:418-425.)Key Words: ABCD2 score ◼ prognosis ◼ stroke ◼ transient ischemic attack

Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

“…Later, many experts make verification on the results of ABCD3 and corresponding ABCD3I. 2,15,17,23,24 Researchers at home and abroad have carried out in accordance with the ABCD3I score validation grouping amount samples of TIA patients into low-risk group (0-3), moderate group (4-7), high-risk group (8 to 13 points) for investigation and study analysis , the results show that the incidence of stroke after TIA within 7 d is: low-risk group < moderate group < high-risk group (differences are statistically significant); Incidence of stroke within 90 d, low-risk group of < moderate group < high-risk groups (the difference had statistical significance), compared with low risk and moderate group, Incidence of stroke within 7 d and 90 d after TIA in high-risk groups were significantly higher, incidence of cerebral infarction within 90 d after TIA in the intermediate risk category is higher than lower dangerous group, the difference was statistically significant. ABCD3I score 8 or more, incidence of stroke within the 7 d after TIA became significantly higher, and when ABCD3I score 4 or more the incidence of stroke points within 90 d after TIA became significantly higher, when ABCD3I score 3 points or less, cerebral infarction was not be found within 7 d, 90 d. It indicates with ABCD3 score higher, there will be possible to become cerebral infarction, indirectly suggest most patients whose ABCD3I score <3 with TIA don't need observation in hospitable, they was medically treated mainly with antiplatelet aggregation of secondary prevention; due to patients with TIA scored 4 to 7 points is the largest number and account for large proportion, they need to be alert to the occurrence of cerebral infarction and if conditions allowed they can be in hospital; Patients scored 8 points or more should be treated as first priority, and should be admitted to hospital as soon as possible and improve the imaging, serology and related inspection and then key intervention and treatment.…”

“…There are foreign scholars scored the large sample TIA patients according to ABCD2, ABCD3, ABCD3I ratings, and were followed up for 3 years, using COX regression model risk proportion to make the comparison to the scoring system, the results also suggest that ABCD3 and ABCD3I scoring system is superior than ABCD2 score on the predictive value of stroke after TIA. 23 Similarly, domestic researchers make a comparison to the moderate amount of samples of TIA patients according to ABCD2, ABCD2I, ABCD3, ABCD3I scoring methods, found that predicting stroke risk within 7 d after TIA, ABCD2, ABCD2I, ABCD3, ABCD3I scoring area under the curve (area under the receiver operating characteristics curve, AUC) are 0.733, 0.898, 0.830 and 0.733 respectively; Predict TIA within 90d after stroke risk was 0.699, 0.857, 0.788 and 0.699respectively, so the study says ABCD3I scoring method is more accurate than ABCD2 and ABCD2I scoring method in predicting TIA back stroke risk, coming with higher clinical value. 25 ABCD, ABCD2and ABCD3 score mainly based on clinical characteristics and are simple, easy, and have a good effect on prediction, but the lack of a TIA etiology, risk factors, imaging and laboratory test, and other auxiliary examination joining, resulting in lacking specificity.…”

Stroke Prediction Context-Aware Health Care System

“…The original ABCD score is one of the most famous applicable risk scores [7]. In 2007, Purroy et al [5] suggested a new risk score called ABCD2, then in 2010, Lavallée et al [6] suggested two new risk scores to predict stroke occurrence earlier in time after a patient suffers from TIA.…”

“…The two new risk scores are named ABCD3 and ABCD3-1. As shown in [7] ABCD3-I(c/i) is the best to use in order to predict the occurrence of a stroke using risk factors for TIA Patient during seven days after TIA.…”

“…As in [7] the following elements are the risk factors of stroke and each risk factor had a probability: …”