Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: The North Dublin TIA study

Orla C. Sheehan, Lorraine Kyne, Lisa A. Kelly, Niamh Hannon, Michael Marnane, Aine Merwick, Patricia M.E. McCormack, Joseph Duggan, Alan Moore, Joan Moroney, Leslie Daly, Dawn Harris, Gillian Horgan, Emma B. Williams, Peter J. Kelly

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE-: Transient ischemic attack (TIA) etiologic data and the ABCD2 score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD2 score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA. METHODS-: Patients with TIA in the North Dublin city population (N=294 529) were ascertained by using overlapping hospital and community sources. The relations between individual ABCD2 items, carotid stenosis, atrial fibrillation, and early stroke were examined. RESULTS-: In confirmed TIA cases (n=443), carotid stenosis predicted 90-day stroke (hazard ratio=2.56; 95% CI, 1.27 to 5.15, P=0.003). Stroke risk rose with increasing grade of carotid stenosis, ranging from 5.4% (95% CI, 3.3% to 8.7%) with <50% stenosis to 17.2% (95% CI, 9.7% to 29.7%) with severe stenosis/occlusion (hazard ratio=3.3; 95% CI, 1.5 to 7.4, P=0.002). In confirmed TIA cases (n=443), the ABCD 2 score performed no better than chance for prediction of 90-day stroke (c-statistic=0.55; 95% CI, 0.45 to 0.64), largely related to the 24.2% (8/33) of patients who experienced a recurrence and had low ABCD2 scores (0-3). However, in nonspecialist-suspected TIA cases (n=700), the predictive utility improved for stroke at 28 (c-statistic=0.61; 95% CI, 0.50 to 0.72) and 90 (c-statistic=0.61; 95% CI, 0.52 to 0.71) days. CONCLUSIONS-: In a population-based TIA cohort, significant predictive information was provided by carotid stenosis. The ABCD2 score had predictive utility in patients with TIA suspected by nonspecialists. Low scores occurred in several patients with stroke recurrences, suggesting that caution is needed before using the score in isolation.

Original languageEnglish (US)
Pages (from-to)844-850
Number of pages7
JournalStroke
Volume41
Issue number5
DOIs
StatePublished - May 1 2010
Externally publishedYes

Keywords

  • ABCD score
  • Carotid stenosis
  • Cerebrovascular disorders
  • Transient ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Fingerprint Dive into the research topics of 'Population-based study of ABCD<sup>2</sup> score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: The North Dublin TIA study'. Together they form a unique fingerprint.

  • Cite this

    Sheehan, O. C., Kyne, L., Kelly, L. A., Hannon, N., Marnane, M., Merwick, A., McCormack, P. M. E., Duggan, J., Moore, A., Moroney, J., Daly, L., Harris, D., Horgan, G., Williams, E. B., & Kelly, P. J. (2010). Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: The North Dublin TIA study. Stroke, 41(5), 844-850. https://doi.org/10.1161/STROKEAHA.109.571844