ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke

Journal of Neurology, Jan 2018

Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving < 24 h after symptom onset in a phase where it is unclear, if the event turns out to be a TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke. Outcome parameters were early stroke during stroke unit stay and 3-month ischemic stroke. Of the 5237 TIA and minor stroke patients with prospectively documented ABCD3-I score, 2755 (52.6%) had a TIA by the time-based and 2183 (41.7%) by the tissue-based definition. Of the 2457 (46.9%) patients with complete 3-month followup, corresponding numbers were 1195 (48.3%) for the time- and 971 (39.5%) for the tissue-based definition of TIA. Early and 3-month ischemic stroke occurred in 1.1 and 2.5% of time-based TIA, 3.8 and 5.9% of time-based minor stroke, 1.2 and 2.3% of tissue-based TIA as well as in 3.1 and 5.5% of tissue-based minor stroke patients. Irrespective of the definition of TIA and minor stroke, the risk of early and 3-month ischemic stroke steadily increased with increasing ABCD3-I score points. The ABCD3-I score performs equally in TIA patients in tissue- as well as time-based definition and the same is true for minor stroke patients.

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ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke

Journal of Neurology https://doi.org/10.1007/s00415 ABCD3‑I score and the risk of early or 3‑month stroke recurrence in tissue‑ and time‑based definitions of TIA and minor stroke Lukas Mayer 0 1 2 3 4 5 6 7 Julia Ferrari 0 1 2 3 4 5 6 7 Stefan Krebs 0 1 2 3 4 5 6 7 Christian Boehme 0 1 2 3 4 5 6 7 Thomas Toell 0 1 2 3 4 5 6 7 Benjamin Matosevic 0 1 2 3 4 5 6 7 Alexander Tinchon 0 1 2 3 4 5 6 7 Michael Brainin 0 1 2 3 4 5 6 7 Thomas Gattringer 0 1 2 3 4 5 6 7 Peter Sommer 0 1 2 3 4 5 6 7 Peter Thun 0 1 2 3 4 5 6 7 Johann Willeit 0 1 2 3 4 5 6 7 Wilfried Lang 0 1 2 3 4 5 6 7 Stefan Kiechl 0 1 2 3 4 5 6 7 Michael Knoflach 0 1 2 3 4 5 6 7 For the Austrian Stroke Unit Collaborators 0 1 2 3 4 5 6 7 Michael Knoflach 0 1 2 3 4 5 6 7 0 Department of Neurology , Landeskrankenhaus Feldkirch, Feldkirch , Austria 1 Department of Neurology, Hospital Barmherzige Brueder , Vienna , Austria 2 Department of Neurology, Medical University of Innsbruck , Anichstraße 35, 6020 Innsbruck , Austria 3 Department of Neurology, Hospital Wilhelminenspital Wien , Vienna , Austria 4 Department of Neurology, Hospital Rudolfstiftung Wien , Vienna , Austria 5 Department of Neurology, Medical University of Graz , Graz , Austria 6 Department of Clinical Neurosciences and Preventive Medicine, Danube University Krems , Krems an der Donau , Austria 7 Department of Neurology, University Clinic St. Pölten , Sankt Pölten , Austria Changing definition of TIA from time to a tissue basis questions the validity of the well-established ABCD3-I risk score for recurrent ischemic cerebrovascular events. We analyzed patients with ischemic stroke with mild neurological symptoms arriving < 24 h after symptom onset in a phase where it is unclear, if the event turns out to be a TIA or minor stroke, in the prospective multi-center Austrian Stroke Unit Registry. Patients were retrospectively categorized according to a time-based (symptom duration below/above 24 h) and tissue-based (without/with corresponding brain lesion on CT or MRI) definition of TIA or minor stroke. Outcome parameters were early stroke during stroke unit stay and 3-month ischemic stroke. Of the 5237 TIA and minor stroke patients with prospectively documented ABCD3-I score, 2755 (52.6%) had a TIA by the time-based and 2183 (41.7%) by the tissue-based definition. Of the 2457 (46.9%) patients with complete 3-month followup, corresponding numbers were 1195 (48.3%) for the time- and 971 (39.5%) for the tissue-based definition of TIA. Early and 3-month ischemic stroke occurred in 1.1 and 2.5% of time-based TIA, 3.8 and 5.9% of time-based minor stroke, 1.2 and 2.3% of tissue-based TIA as well as in 3.1 and 5.5% of tissue-based minor stroke patients. Irrespective of the definition of TIA and minor stroke, the risk of early and 3-month ischemic stroke steadily increased with increasing ABCD3-I score points. The ABCD3-I score performs equally in TIA patients in tissue- as well as time-based definition and the same is true for minor stroke patients. Transient ischemic attack; Minor stroke; ABCD3-I; Risk prediction; Time-based; Tissue-based Introduction TIA and minor stroke are both conditions with high risk for early neurologic worsening and recurrent ischemic stroke [ 1 ]. To estimate the individual risk, scores have been proposed with the ABCD2 and ABCD3-I (Table 1) scores being the best validated and predominantly used risk evaluators in TIA patients [ 2–4 ]. The original definition of a TIA in the late 1950s was time-based relying mainly on symptom duration < 24 h [ 5–8 ]. Advances in and availability of cerebral imaging since then have led to the suggestion of a re-definition of TIA based on imaging findings depending on the absence of an ischemic brain damage [9]. The tissue-based approach may assist in differentiating TIA from minor stroke patients earlier than the time-based definition ABCD3-score ABCD3-I-score aTIA prompting medical attention plus at least one other TIA in the preceding 7 days as patients who are admitted earlier than the 24-h time window for symptom relief could not be divided between the two. This imaging-based definition is highly likely to be implemented in the upcoming International Classification of Diseases (ICD) 11 [ 10 ]. The ABCD2 score has previously been shown to work equally in the tissue-based definition of TIA and minor stroke [ 11 ]. The aim of this study was to evaluate the prognostic value of the more advanced ABCD3I score in tissue- as well as time-based definitions of TIA and minor stroke. Materials and methods Data were collected from the Austrian Stroke Unit Registry which is prospectively filled with data from 37 stroke units all over Austria. This registry was established in 2003 and documents patient characteristics, diagnostic and clinical information upon admission, discharge and 3-month followup on every person who was admitted to a stroke unit in Austria. High quality data are generated through immediate documentation, online pla (...truncated)


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Lukas Mayer, Julia Ferrari, Stefan Krebs, Christian Boehme, Thomas Toell, Benjamin Matosevic, Alexander Tinchon, Michael Brainin, Thomas Gattringer, Peter Sommer, Peter Thun, Johann Willeit, Wilfried Lang, Stefan Kiechl, Michael Knoflach, For the Austrian Stroke Unit Collaborators. ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke, Journal of Neurology, 2018, pp. 1-5, DOI: 10.1007/s00415-017-8720-8