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External validation of ABCD series scores for predicting early stroke events following transient ischemic attack in a large nationwide registry

First author：Jia-Xu Weng,Hong-Qiu Gu,Shang Wang

Corresponding author：Zi-Xiao Li

Scale risk score stroke events transient ischemic attack

essential_information

2022-07-18

Published articles

Journal：European Stroke Journal

Publication type: Original Contributions

IF(IF): 5.894

PMID: 36478753 Link To Pubmed Full text Download

Background And Purpose

In the context of modern guideline-based strategies, new validations of prognostic scores for predicting early stroke risk are needed. We aimed to compare the validity of the ABCD series scores and assess the incremental values of risk components for predicting in-hospital stroke events in patients with transient ischemic attack (TIA)

Method

We abstracted data from the Chinese Stroke Center Alliance (CSCA), a nationwide registry with 68,433 TIA patients admitted within 7 days of symptom onset from 1476 hospitals. TIA was defined by timebased criteria according to the World Health Organization (WHO). The discrimination of ABCD, ABCD2, ABCD2-I, and ABCD3 scores for predicting in-hospital stroke events was assessed by the area under the receiver-operating characteristics curves (AUC). The incremental predictive values of added risk predictor were determined by net reclassification improvement (NRI) and integrated discrimination improvement (IDI).

Conclusion

The traditional scales utilizing medical history (ABCD, ABCD2, and ABCD3 scores) show fair ability for predicting in-hospital stroke events after TIA, but the ABCD2-I score, which adds infarction on DWI, improves the predictive ability.

Main results

A total of 29,286 TIA patients were included, of whom 1466 (5.0%) had in-hospital stroke events. Compared with ABCD2-I score (AUC 0.79, 95% confidence interval [CI] 0.77–0.80), ABCD (AUC 0.58, 95% CI 0.57–0.60), ABCD2 (AUC 0.58, 95% CI 0.56–0.59), and ABCD3 (AUC 0.58, 95% CI 0.56–0.60) had lower predictive utility. An incremental value was observed when adding infarction on DWI (IDI = 0.0597, NRI = 1.1036) into ABCD2 score to be ABCD2-I.