Abstract 3470: A Simple Score (ACVS) to Identify Patients at High Risk of Recurrent Stroke or Death during 1Year after Transient Ischemic Attack or Minor Ischemic Stroke.

Abstract

Background and Purpose: Transient ischemic attack (TIA) and minor ischemic stroke is critical warning sign of following disabling stroke. Recently, the concept of acute cerebrovascular syndrome (ACVS) is advocated for early diagnosis and management of TIA or minor stroke. We thought to determine whether the early examination findings at admission can predict the recurrent stroke or death during 1 year after the qualifying event. Methods: Between April 2006 and July 2009, 621patients with TIA or minor ischemic stroke (defined as an National Institutes of Health Stroke Scale [NIHSS] score ≤3) were admitted to our stroke center within 7 days after the onset. Among them, 494 patients obtained outcome at 1year were analyzed. Background data including the findings of laboratory examination, brain MRI diffusion weighted image (DWI), brain MRA and carotid ultrasound were obtained within 3 days after the admission. Information about recurrent stroke and/or death from any cause within 1 year after the qualifying event was obtained from clinical record or telephone interview. Results: During 1 year after the qualifying events, further stroke were identified in 46 (9.3%) patients, 19 (3.9%) patients died, and a total of 60 (12.2%) patients had composite incident of recurrent stroke or death. Multivariate logistic regression analysis showed that age ≥ 60 years old (hazard ratio, 3.00), female sex (hazard ratio, 1.98), history of previous stroke (hazard ratio, 2.10), serum CRP level ≥ 0.2mg/dL (hazard ratio, 2.59), intracranial or carotid artery stenosis ≥ 50% (hazard ratio, 1.76) and acute infarction on DWI (hazard ratio, 3.62) were found to be independent risk factors for recurrent stroke or death. A four-point score derived from these results (acute infarction on DWI [present = 1], CRP level [≥ 0.2mg/dL = 1], vascular stenosis of intracranial or carotid artery [≥ 50% = 1], and stroke history [present = 1]: ACVS) was highly predictive of 1-year risk of recurrent stroke or death (p < 0.001, Figure ). Conclusions: Risk of stroke or death during 1 year after TIA or minor stroke seemed to be highly predictable. Although further validations are needed, the ACVS score may be useful in clinical practice to identify high-risk individuals who need careful treatment and follow up.