ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk.

Fredrik Ildstad,Stian Lydersen,Hild Fjærtoft,Torgeir Wethal,Hanne Ellekjær,Bent Indredavik,Domenico Mezzapesa

doi:10.1155/2021/8845898

Abstract

Objectives We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short- (1 week) and long-term (3 months; 1 year) stroke risk prediction in our post-TIA stroke risk study, MIDNOR TIA. Materials and Methods We performed a prospective, multicenter study in Central Norway from 2012 to 2015, enrolling 577 patients with TIA. In a subset of patients with complete data for both scores (n = 305), we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score. A telephone follow-up and registry data were used for assessing stroke occurrence. Results Within 1 week, 3 months, and 1 year, 1.0% (n = 3), 3.3% (n = 10), and 5.2% (n = 16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week, 0.66 (95% CI, 0.53 to 0.80) at 3 months, and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year. The corresponding AUCs for the ABCD2 score were 0.55 (95% CI, 0.24 to 0.86), 0.55 (95% CI, 0.42 to 0.68), and 0.63 (95% CI, 0.50 to 0.76). Conclusions The ABCD3-I score had limited value in a short-term prediction of subsequent stroke after TIA and did not reliably discriminate between low- and high-risk patients in a long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since there is a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited. Clinical Trial Registration. This trial is registered with NCT02038725 (retrospectively registered, January 16, 2014).

Highlights

Patients with transient ischemic attacks (TIA) are at risk of subsequent strokes, especially early after the attack [1, 2]
Of the 577 patients included in the original study, 305 patients had complete data for secondary analysis of both the ABCD3-I and ABCD2 scores
361 had MRI performed at any time 23 excluded because MRI not performed within 7 days 338 had MRI performed within 7 days of index TIA and before stroke onset

Summary

Introduction

Patients with transient ischemic attacks (TIA) are at risk of subsequent strokes, especially early after the attack [1, 2]. Urgent assessment and intervention is essential in preventing strokes in patients with TIA [3, 4]. Accurate identification of patients at highest risk of stroke after TIA has been considered important in the clinical evaluation and management of these patients. In the last two decades, clinical scores have been established to estimate the stroke risk following a TIA, with the ABCD2 and the ABCD3-I scores being the best validated ones (see Table 1). The ABCD2 score was originally developed to aid nonspecialists in community-based referring settings in management of TIA patients [5]. The ABCD3-I score was developed for use in secondary care and includes information from initial diagnostic investigations [6]

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