| Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. | |
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MedLine Citation:
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PMID: 21865578 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Stroke risk immediately after TIA defined by time-based criteria is high, and prognostic scores (ABCD2 and ABCD3-I) have been developed to assist management. The American Stroke Association has proposed changing the criteria for the distinction between TIA and stroke from time-based to tissue-based. Research using these definitions is lacking. In a multicenter observational cohort study, we have investigated prognosis and performance of the ABCD2 score in TIA, subcategorized as tissue-positive or tissue-negative on diffusion-weighted imaging (DWI) or CT imaging according to the newly proposed criteria. METHODS: Twelve centers provided data on ABCD2 scores, DWI or CT brain imaging, and follow-up in cohorts of patients with TIA diagnosed by time-based criteria. Stroke rates at 7 and 90 days were studied in relation to tissue-positive or tissue-negative subcategorization, according to the presence or absence of brain infarction. The predictive power of the ABCD2 score was determined using area under receiver operator characteristic curve (AUC) analyses. RESULTS: A total of 4,574 patients were included. Among DWI patients (n = 3,206), recurrent stroke rates at 7 days were 7.1%(95% confidence interval 5.5-9.1) after tissue-positive and 0.4% (0.2-0.7) after tissue-negative events (p diff < 0.0001). Corresponding rates in CT-imaged patients were 12.8% (9.3-17.4) and 3.0% (2.0-4.2), respectively (p diff < 0.0001). The ABCD2 score had predictive value in tissue-positive and tissue-negative events (AUC = 0.68 [95% confidence interval 0.63-0.73] and 0.73 [0.67-0.80], respectively; p sig < 0.0001 for both results, p diff = 0.17). Tissue-positive events with low ABCD2 scores and tissue-negative events with high ABCD2 scores had similar stroke risks, especially after a 90-day follow-up. CONCLUSIONS: Our findings support the concept of a tissue-based definition of TIA and stroke, at least on prognostic grounds. |
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Authors:
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M F Giles; G W Albers; P Amarenco; E M Arsava; A W Asimos; H Ay; D Calvet; S B Coutts; B L Cucchiara; A M Demchuk; S C Johnston; P J Kelly; A S Kim; J Labreuche; P C Lavallee; J-L Mas; A Merwick; J M Olivot; F Purroy; W D Rosamond; R Sciolla; P M Rothwell |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review Date: 2011-08-24 |
Journal Detail:
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Title: Neurology Volume: 77 ISSN: 1526-632X ISO Abbreviation: Neurology Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-09-28 Completed Date: 2011-11-15 Revised Date: 2012-04-25 |
Medline Journal Info:
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Nlm Unique ID: 0401060 Medline TA: Neurology Country: United States |
Other Details:
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Languages: eng Pagination: 1222-8 Citation Subset: AIM; IM |
Affiliation:
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Stroke Prevention Research Unit, NIHR Biomedical Research Centre, Oxford University Department of Clinical Neurology, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK. matthew.giles@clneuro.ox.ac.uk |
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| MeSH Terms | |
Descriptor/Qualifier:
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Area Under Curve Cohort Studies Diffusion Magnetic Resonance Imaging Female Humans International Cooperation Ischemic Attack, Transient / diagnosis* Male Predictive Value of Tests Risk Factors Severity of Illness Index* Statistics, Nonparametric Stroke / diagnosis Time Factors Tomography, X-Ray Computed |
| Grant Support | |
ID/Acronym/Agency:
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R01 NS059710-03/NS/NINDS NIH HHS; R01 NS059710-04/NS/NINDS NIH HHS |
| Comments/Corrections | |
Comment In:
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Neurology. 2012 Mar 20;78(12):e77-9
[PMID:
22431744
]
J Neurol. 2011 Nov;258(11):2107-9 [PMID: 22037951 ] Neurology. 2012 Jan 17;78(3):224 [PMID: 22249498 ] |
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