Is the ABCD Score Useful for Risk Stratification of Patients With Acute Transient Ischemic Attack?

Abstract

Background and Purpose-A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score Ͻ4 reportedly indicates minimal short-term stroke risk. We evaluated this scoring system in an independent population. Methods-This was a prospective study of TIA patients (diagnosed by a neurologist using the classic Ͻ24-hour definition) hospitalized Ͻ48 hours from symptom onset. The primary outcome assessment consisted of dichotomization of patients into 2 groups. The high-risk group included patients with stroke or death within 90 days, Ն50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWIϩ or DWIϪ. Results-Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with Ն50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trendϭ0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWIϩ, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trendϭ0.24). Conclusions-Although the ABCD score has some predictive value, patients with a score Ͻ4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.

Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

“…17 The presence of ischemic lesions on DWI or large artery occlusion is another predictor for recurrent stroke after TIA. [22][23][24][25][26] Although the association between FVH and poor outcome in patients with IS was demonstrated, 27,28 the association between FVH and recurrence of TIA or IS after TIA has been merely reported. 29 In the present study, Cox proportional hazard analysis showed that recurrence within 90 days after onset was associated with AOL and FVH, as well as coexistence of these 2.…”

Lipoprotein-Associated Phospholipase A 2 and C-Reactive Protein for Risk-Stratification of Patients With TIA

“…A detailed description of our study methodology has been published previously. 6 Informed consent was obtained from all subjects and the protocol was approved by our local Institutional Review Board.…”

ABCD2 Scores and Prediction of Noncerebrovascular Diagnoses in an Outpatient Population

“…Attempts to validate ABCDbased scoring in independent populations have been generally, 3 but not universally, successful. 4 Some groups have questioned the usefulness of a score that does not incorporate significant carotid disease or other potential cardioembolic source. 5 More importantly, in all ABCD validation exercises, the underlying diagnosis has been assumed to be TIA.…”