Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients

The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the pr...

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Published in:Stroke (1970) 2010-09, Vol.41 (9), p.1907-1913
Main Authors: Giles, Matthew F, Albers, Greg W, Amarenco, Pierre, Arsava, Murat M, Asimos, Andrew, Ay, Hakan, Calvet, David, Coutts, Shelagh, Cucchiara, Brett L, Demchuk, Andrew M, Johnston, S Claiborne, Kelly, Peter J, Kim, Anthony S, Labreuche, Julien, Lavallee, Philippa C, Mas, Jean-Louis, Merwick, Aine, Olivot, Jean Marc, Purroy, Francisco, Rosamond, Wayne D, Sciolla, Rossella, Rothwell, Peter M
Format: Article
Language:English
Subjects:
Brain Infarction - diagnosis
Female
Humans
Ischemic Attack, Transient - diagnosis
Male
Prognosis
Risk
Risk Assessment
Risk Factors
Stroke - diagnosis
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Summary:The ABCD system was developed to predict early stroke risk after transient ischemic attack. Incorporation of brain imaging findings has been suggested, but reports have used inconsistent methods and been underpowered. We therefore performed an international, multicenter collaborative study of the prognostic performance of the ABCD(2) score and brain infarction on imaging to determine the optimal weighting of infarction in the score (ABCD(2)I). Twelve centers provided unpublished data on ABCD(2) scores, presence of brain infarction on either diffusion-weighted imaging or CT, and follow-up in cohorts of patients with transient ischemic attack diagnosed by World Health Organization criteria. Optimal weighting of infarction in the ABCD(2)I score was determined using area under the receiver operating characteristic curve analyses and random effects meta-analysis. Among 4574 patients with TIA, acute infarction was present in 884 (27.6%) of 3206 imaged with diffusion-weighted imaging and new or old infarction was present in 327 (23.9%) of 1368 imaged with CT. ABCD(2) score and presence of infarction on diffusion-weighted imaging or CT were both independently predictive of stroke (n=145) at 7 days (after adjustment for ABCD(2) score, OR for infarction=6.2, 95% CI=4.2 to 9.0, overall; 14.9, 7.4 to 30.2, for diffusion-weighted imaging; 4.2, 2.6 to 6.9, for CT; all P
ISSN:1524-4628
1524-4628
DOI:10.1161/strokeaha.110.578971