Population-Based Study of ABCD ² Score, Carotid Stenosis, and Atrial Fibrillation for Early Stroke Prediction After Transient Ischemic Attack

Abstract

Background and Purpose-Transient ischemic attack (TIA) etiologic data and the ABCD 2 score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD

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

“…Incidence of stroke in the high-risk group is 2-8 times higher than that of the low-risk and moderate group; incidence of secondary stroke in low-risk, moderate-risk and high-risk groups reached 3.1%, 9.8%, 17.8%, respectively, within 90 d. incidence of secondary stroke in medium and high-risk groups accounting for about 90%, are higher than that of the low-risk group. 2,14,15 Other studies demonstrated that TIA patients in low-risk (0-3 points), moderate-risk (4-5 points), high-risk groups (6-7 points) presented incidence of cerebral infarction of 3%, 31% and 3%, respectively (P<0.05) within 7 d. TIA patients with secondary to cerebral infarction within 7 d probability and linear correlation between ABCD2 score showed that high score indicates high incidence of cerebral infarction; ABCD2 score >6 displays highest incidence in patients, and risk of recurrence of cerebral infarction is seven times higher than that of other patients. 16,17 To date, numerous studies proved that efficiency of ABCD2 score for early prediction of cerebral infarction after TIA value is higher than that of ABCD score method, with recommendations of AHA/ASA for clinical evaluation of the prognosis of patients with TIA risk method.…”

“…2 In recent years, a growing number of studies have shown that ABCD2 score for prediction of stroke after TIA features more limitations because of lack of etiology assessment, making ABCD2 score prediction value questionable. 2,15,17 …”

“…Scholars can estimate of risk for stroke after TIA based on ABCD2 score and whether there are infarcts in and CT and DWI, the result shows: the TIA within 7 d and 30 d after cerebral infarction predicted rate increased by 18%. 15,20,22 Due to the lack of appreciation of ABCD2I on the artery stenosis, so affected its predictive value, resulting in limitations in clinical practice. …”

“…2,8,9,11,22 In 2010, researchers established ABCD3 and ABCD3I score. 15 Which on the basis of the ABCD2 added an index in ABCD3: double TIA (TIA attack 2 times or more within 7 days, 2points), the total score nine points; ABCD3I score increased three indicators (double TIA, ipsilateral carotid stenosis, positive DWI), a total of eight items: age 60 years or more (1 point), blood pressure >140/90 MMHG (1 point), clinical symptoms (words damaged 1 points; partial side limb weakness 2 points), duration of symptoms (10-59 minutes 1point; 2 minutes and 60 minutes or higher), diabetes (1 point), double TIA, carotid stenosis and positive DWI (2 points), and all score of 13 points.…”

“…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.…”