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ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk
Fredrik Ildstad1,2, Hanne Ellekjær1,2, Torgeir Wethal1,2
1Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Insights
The ABCD3-I score showed limited ability to predict stroke risk after transient ischemic attack (TIA). Neither the ABCD3-I nor the ABCD2 score accurately identified high-risk patients, suggesting limited clinical utility for these tools.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Transient ischemic attack (TIA) is a critical warning sign for future stroke.
- Accurate risk stratification is essential for timely intervention and management of TIA patients.
- Existing clinical risk scores, such as ABCD2, have limitations in predicting stroke risk.
Purpose of the Study:
- To evaluate the performance of the ABCD3-I score in predicting short- and long-term stroke risk after TIA.
- To compare the predictive accuracy of the ABCD3-I score against the ABCD2 score.
- To assess the clinical utility of these scores in the MIDNOR TIA study.
Main Methods:
- Prospective, multicenter study involving 577 TIA patients in Central Norway (2012-2015).
- Calculation of Area Under the Curve (AUC) statistics for ABCD3-I and ABCD2 scores in a subset of 305 patients with complete data.
- Stroke occurrence was determined through telephone follow-up and registry data at 1 week, 3 months, and 1 year.
Main Results:
- Stroke incidence was 1.0% at 1 week, 3.3% at 3 months, and 5.2% at 1 year.
- ABCD3-I score AUCs were 0.72 (1 week), 0.66 (3 months), and 0.68 (1 year).
- ABCD2 score AUCs were 0.55 (1 week), 0.55 (3 months), and 0.63 (1 year), indicating limited predictive accuracy for both scores.
Conclusions:
- The ABCD3-I score demonstrated limited value in short-term stroke prediction post-TIA.
- Neither score reliably discriminated between low- and high-risk patients in long-term follow-up.
- The overall lower stroke risk in recent years may limit the benefit and role of these clinical risk scores in TIA management.
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).
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