Abstract T P164: New ABC (Age, Blood Pressure, and Clinical Features) Score Can Predict Early Ischemic Stroke After Transient Ischemic Attack

Abstract

Background and Purpose: Several clinical scales, such as the ABCD2 score, were developed for predicting early stroke after transient ischemic attack (TIA). We aimed to derive a new score from our TIA registry. Methods: The PROMISE-TIA registry was a multicenter prospective study in Japan. From June 2011 to December 2013, 1353 patients within 7 days of TIA onset were enrolled. Among them, we analyzed 1277 patients (822 men, 69.5 ± 12.4 years) who completed followed-up at 90 days after TIA onset. The components of the score were determined by the multivariate Cox proportional hazards model. We included them into the analysis if the p-value was under 0.1. The accuracy of our score was compared to that of the ABCD2, ABCD3, and ABCD3-I scores by using the C-statistics. Results: Cox hazard model showed that age≧80 years (HR: 1.91; 95%CI: 0.95-3.61, p=0.069), systolic blood pressure (SBP)≧160 or diastolic blood pressure (DBP)≧90 at presentation (HR: 4.05; 95%CI: 2.01-9.05, p<0.001), hemiparesis (HR: 4.05; 95%CI: 1.23-8.27, p=0.0124), and speech disturbance (HR: 2.68; 95%CI: 1.39-5.57, p=0.0026) were related to ischemic stroke within 7 days. One point was given for each of the following factors : age≧80, SBP≧160 or DBP≧90, hemiparesis, and speech disturbance. The sum of these scores was defined as “ABC score”. The 7-day ischemic stroke risk was 0% for ABC score of 0, 1.37% (0.52-3.62) for 1, 2.06% (1.14-3.67) for 2, 6.36% (4.19-9.56) for 3, 16.7% (8.15-31.0) for 4. The 90-days ischemic stroke risk was 2.50% (0.63-9.45), 3.44% (1.86-6.29), 3.74% (2.43-5.73), 9.70% (6.94-13.4), and 16.7% (8.15-31.0), respectively. The incidence of ischemic stroke was significantly higher in patients with a score of 3-4 than those with a score of 0-2; HR being 3.27 (1.19-11.5) for 7 days and 2.76 (1.35-6.20) for 90 days. The C-statistics of the ABC score was significantly higher than that of the ABCD2, ABCD3, or ABCD3-I score (vs. ABCD2: 0.721 vs. 0.596, p=0.0011, vs. ABCD3: 0.721 vs. 0.597, p=0.0087, vs. ABCD3-I: 0.720 vs. 0.566, p=0.0050). Conclusions: Our ABC score can be useful for predicting risk of ischemic stroke within 7 days and 90days after TIA onset.