Key result
ABCD2 score predicts 7-day recurrent stroke equally well in posterior versus anterior circulation TIA.
Why the study?
Previous studies reported the ABCD2 score could predict stroke risk after anterior circulation TIA but might have limitations for posterior circulation TIA.
Does the ABCD2 score predict recurrent stroke risk equivalently in anterior and posterior circulation TIA with infarction?
Cohort (n=494)
No
Does the ABCD2 score predict recurrent stroke risk equivalently in anterior and posterior circulation TIA with infarction?
The ABCD2 score has equivalent predictive ability for short-term recurrent stroke risk in patients with anterior and posterior circulation TIA when classified accurately by neuroimaging.
Equivalent ABCD2 performance across TIA circulations supports unified risk stratification; leaves open prospective validation before practice change.
Transient ischemic attack (TIA) was clinically divided into anterior circulation (AC) or posterior circulation (PC). Previous study reported that ABCD2 score could predict the stroke risk after AC-TIA but might have limitation for PC-TIA. We aimed to classify TIA depending on neuroimaging and assess the value of ABCD2 score for predicting stroke risk in different territories. Research data was from TIA database of the First Affiliated Hospital of Zhengzhou University. TIA patients with acute infarction on diffuse weighted imaging [that is, transient symptoms with infarction (TSI)] were divided into anterior and posterior circulation groups according to the location of infarction. The outcome was recurrent stroke within 7 and 90 days. The predictive power of ABCD2 score was determined using area under receiver operator characteristic curve (AUC) analyses. Overall, 382 AC-TSI and 112 PC-TSI patients were included. There were 38 (9.9%) AC-TSI patients and 11(9.8%) PC-TSI patients who had recurrent stroke at 7 days, and 66 (17.3%) AC-TSI patients and 19 (17.0%) PC-TSI patients who had recurrent stroke within 90 days. At 7 days, the AUC for ABCD2 score was 0.637 (95% confidence interval CI 0.554-0.720) in anterior circulation and 0.683 (95% CI 0.522-0.845) in posterior circulation. The C statistics for ABCD2 score in the two groups were not statistically significant (Z = - 0.499; P = 0.62). Similar result was found when the outcome time-point was set at 90 days. ABCD2 score could predict the short-term risk of recurrent stroke after AC-TSI and PC-TSI, and had similar predictive abilities for AC-TSI and PC-TSI.
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Cao et al. (2023) conducted a cohort in Transient ischemic attack with acute infarction (TSI) (n=494). ABCD2 score in posterior circulation TSI vs. ABCD2 score in anterior circulation TSI was evaluated on Predictive power (AUC) of ABCD2 score for recurrent stroke at 7 days (p=0.62). The ABCD2 score demonstrated equivalent predictive ability for 7-day recurrent stroke risk in posterior circulation TIA (AUC 0.683) compared to anterior circulation TIA (AUC 0.637).
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