Abstract 3064: Validation of ABCD3-I Score: Predictive Value of Brain and Vascular Imaging in Transient Ischemic Attack Patients

Abstract

Objective: Diffusion-weighted magnetic resonance imaging (DWI) is not only a sensitive diagnostic tool for detecting acute ischaemic lesions in patients with transient ischaemic attacks (TIAs) but also a prognostic tool. Morever, large-artery aterosclerosis (LAA) is a marker of poor prognosis. Recently, brain and vascular imaging have been added to a new prognostic score: ABCD(3)-I score. Methods: We analyzed data from TIA patients of the PROMAPA study who underwent diffusion weighted imaging (DWI) within 7 days of symptom onset. Items that contribute to the ABCD(3)-I score (age, blood pressure, clinical weakness, duration, diabetes, LAA, recurrence events and DWI), other clinical variables and stroke recurrence at seven- and 90-day follow-up were recorded. RESULTS: 462 TIA patients were included in the study. DWI abnormalities were identified in 117 (46.1%) patients. During follow-up, eight patients (1.7%) had a stroke within 7 days, and 14 (3.1%) had a stroke within 3 months. In cox proportional In the Cox logistic regression model, the combination of LAA and positive DWI remained as independent predictors of stroke recurrence at 90-day follow-up (HR 8.23, 95 CI 2.89-23.46, p<0.001). The area under the receiver operating characteristic curve was 0.79 (0.68-0.91, p=0.005) at 7 days and 0.67 (0.51-0.83, p=0.029) at 90 days. Conclusion: The combination of neuroimaging and vascular information improve prognostic accuracy in patients with TIA. ABCD3-I could select patients at high risk of very early recurrent stroke who need immediate evaluation and treatment.