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

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

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).

Conflict of interest statement

The authors report no conflicts of interest.

Copyright © 2021 Fredrik Ildstad et al.

Figures

Figure 1
Figure 1
Flow chart of study profile.
Figure 2
Figure 2
ROC curves of the ABCD3-I score and ABCD2 score at 1 week (a), 3 months (b), and 1 year (c).

References

    1. Johnston S. C., Gress D. R., Browner W. S., Sidney S. Short-term prognosis after emergency department diagnosis of TIA. Jama. 2000;284(22):2901–2906. doi: 10.1001/jama.284.22.2901.
    1. Lisabeth L. D., Ireland J. K., Risser J. M., et al. Stroke risk after transient ischemic attack in a population-based setting. Stroke. 2004;35(8):1842–1846. doi: 10.1161/01.STR.0000134416.89389.9d.
    1. Rothwell P. M., Giles M. F., Chandratheva A., et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432–1442. doi: 10.1016/s0140-6736(07)61448-2.
    1. Lavallée P. C., Meseguer E., Abboud H., et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. The Lancet Neurology. 2007;6(11):953–960. doi: 10.1016/S1474-4422(07)70248-X.
    1. Johnston S. C., Rothwell P. M., Nguyen-Huynh M. N., et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292. doi: 10.1016/s0140-6736(07)60150-0.
    1. Merwick A., Albers G. W., Amarenco P., et al. Addition of brain and carotid imaging to the ABCD2 score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. The Lancet Neurology. 2010;9(11):1060–1069. doi: 10.1016/s1474-4422(10)70240-4.
    1. Ildstad F., Ellekjær H., Wethal T., et al. Stroke risk after transient ischemic attack in a Norwegian prospective cohort. BMC Neurology. 2019;19(1, article 1225):p. 2. doi: 10.1186/s12883-018-1225-y.
    1. Helsedirektoratet. Nasjonal retningslinje for behandling og rehabilitering ved hjerneslag. 2010.
    1. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin of the World Health Organization. 1976;54(5):541–553.
    1. Aho K., Harmsen P., Hatano S., Marquardsen J., Smirnov V. E., Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bulletin of the World Health Organization. 1980;58(1):113–130.
    1. Newson R. Confidence Intervals for Rank Statistics: Somers’ D and Extensions. The Stata Journal. 2006;6(3):309–334. doi: 10.1177/1536867x0600600302.
    1. Kelly P. J., Albers G. W., Chatzikonstantinou A., et al. Validation and comparison of imaging-based scores for prediction of early stroke risk after transient ischaemic attack: a pooled analysis of individual- patient data from cohort studies. The Lancet Neurology. 2016;15(12):1238–1247. doi: 10.1016/s1474-4422(16)30236-8.
    1. Song B., Fang H., Zhao L., et al. Validation of the ABCD3-I score to predict stroke risk after transient ischemic attack. Stroke. 2013;44(5):1244–1248. doi: 10.1161/strokeaha.113.000969.
    1. Kiyohara T., Kamouchi M., Kumai Y., et al. ABCD3 and ABCD3-I scores are superior to ABCD2 score in the prediction of short- and long-term risks of stroke after transient ischemic attack. Stroke. 2014;45(2):418–425. doi: 10.1161/strokeaha.113.003077.
    1. Purroy F., Jiménez Caballero P. E., Gorospe A., et al. Prediction of early stroke recurrence in transient ischemic attack patients from the PROMAPA study: a comparison of prognostic risk scores. Cerebrovascular Diseases (Basel, Switzerland) 2012;33(2):182–189. doi: 10.1159/000334771.
    1. Purroy F., Jiménez-Caballero P. E., Mauri-Capdevila G., et al. Predictive value of brain and vascular imaging including intracranial vessels in transient ischaemic attack patients: external validation of the ABCD3-I score. European Journal of Neurology. 2013;20(7):1088–1093. doi: 10.1111/ene.12141.
    1. Amarenco P., Lavallée P. C., Labreuche J., et al. One-year risk of stroke after transient ischemic attack or minor stroke. The New England Journal of Medicine. 2016;374(16):1533–1542. doi: 10.1056/NEJMoa1412981.
    1. Cucchiara B. L., Messe S. R., Taylor R. A., et al. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke. 2006;37(7):1710–1714. doi: 10.1161/01.str.0000227195.46336.93.
    1. Lovett J. K., Dennis M. S., Sandercock P. A., Bamford J., Warlow C. P., Rothwell P. M. Very early risk of stroke after a first transient ischemic attack. Stroke. 2003;34(8):e138–e140. doi: 10.1161/01.str.0000080935.01264.91.
    1. Dahlquist R. T., Young J. M., Reyner K., et al. Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department. The American journal of emergency medicine. 2020;38(4):741–745. doi: 10.1016/j.ajem.2019.06.018.
    1. National Guideline Centre (UK) Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. London: National Institute for Health and Care Excellence (UK); 2019.
    1. Kernan W. N., Ovbiagele B., Black H. R., et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic Attack. Stroke. 2014;45(7):2160–2236. doi: 10.1161/STR.0000000000000024.
    1. Albers G. W., Caplan L. R., Easton J. D., et al. Transient ischemic attack--proposal for a new definition. The New England Journal of Medicine. 2002;347(21):1713–1716. doi: 10.1056/NEJMsb020987.
    1. Appelros P., Hals Berglund M., Strom J. O. Long-term risk of stroke after transient ischemic attack. Cerebrovascular Diseases (Basel, Switzerland) 2017;43(1-2):25–30. doi: 10.1159/000451061.
    1. Rothwell P. M., Algra A., Chen Z., Diener H. C., Norrving B., Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. 2016;388(10042):365–375. doi: 10.1016/s0140-6736(16)30468-8.
    1. Almasi M., Hodjati Firoozabadi N., Ghasemi F., Chardoli M. The value of ABCD2F scoring system (ABCD2 combined with atrial fibrillation) to predict 90-day recurrent brain stroke. Neurology research international. 2016;2016:5. doi: 10.1155/2016/8191659.8191659
    1. Sheehan O. C., Kyne L., Kelly L. A., et al. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study. Stroke. 2010;41(5):844–850. doi: 10.1161/strokeaha.109.571844.
    1. Zhao M., Wang S., Zhang D., Zhang Y., Deng X., Zhao J. Comparison of stroke prediction accuracy of ABCD2 and ABCD3-I in patients with transient ischemic attack: a meta-analysis. Journal of Stroke and Cerebrovascular Diseases. 2017;26(10):2387–2395. doi: 10.1016/j.jstrokecerebrovasdis.2017.05.030.

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