Abstract
Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving < 24 h after symptom onset in a phase where it is unclear, if the event turns out to be a TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke. Outcome parameters were early stroke during stroke unit stay and 3-month ischemic stroke. Of the 5237 TIA and minor stroke patients with prospectively documented ABCD3-I score, 2755 (52.6%) had a TIA by the time-based and 2183 (41.7%) by the tissue-based definition. Of the 2457 (46.9%) patients with complete 3-month followup, corresponding numbers were 1195 (48.3%) for the time- and 971 (39.5%) for the tissue-based definition of TIA. Early and 3-month ischemic stroke occurred in 1.1 and 2.5% of time-based TIA, 3.8 and 5.9% of time-based minor stroke, 1.2 and 2.3% of tissue-based TIA as well as in 3.1 and 5.5% of tissue-based minor stroke patients. Irrespective of the definition of TIA and minor stroke, the risk of early and 3-month ischemic stroke steadily increased with increasing ABCD3-I score points. The ABCD3-I score performs equally in TIA patients in tissue- as well as time-based definition and the same is true for minor stroke patients.
Highlights
TIA and minor stroke are both conditions with high risk for early neurologic worsening and recurrent ischemic stroke [1]
We present here the analysis of a large prospective cohort of patients admitted to an Austrian stroke unit with minor neurological symptoms within a median of 2 h after symptom onset (Table 2) in a phase when it is still unclear if the cerebral ischemia turns out to be a TIA or minor stroke
To the best of our knowledge, we are the first to demonstrate that increasing ABCD3-I score points are associated with a steady increase in early and 3-month stroke risk irrespective if TIA was later classified according to the classic time-based or the upcoming tissue-based definition
Summary
TIA and minor stroke are both conditions with high risk for early neurologic worsening and recurrent ischemic stroke [1]. To estimate the individual risk, scores have been proposed with the ABCD2 and ABCD3-I (Table 1) scores being the best validated and predominantly used risk evaluators in TIA patients [2,3,4]. The original definition of a TIA in the late 1950s was time-based relying mainly on symptom duration < 24 h [5,6,7,8]. Advances in and availability of cerebral imaging since have led to the suggestion of a re-definition of TIA based on imaging findings depending on the absence of an ischemic brain damage [9]. The tissue-based approach may assist in differentiating TIA from minor stroke patients earlier than the time-based definition.
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