DWI lesions and TIA etiology improve the prediction of stroke after TIA.
OBJECTIVE
The ABCD(2) score has been shown to predict the early risk of stroke after transient ischemic attack (TIA). The additional predictive value of diffusion-weighted imaging (DWI) and TIA etiology is not well known.


METHODS
From January 2003 to June 2007, 343 consecutive patients (mean+/-SD age, 62.4+/-15.4 years) with TIA were admitted to our stroke unit. Most (339) patients underwent DWI and all had an etiologic work-up and were followed up for 3 months. The predictive value of the ABCD(2) score, positive DWI findings, large-artery atherosclerosis (LAA), and atrial fibrillation (AF) with respect to occurrence of ischemic stroke at 1 week and 3 months was assessed.


RESULTS
DWI was positive in 136 (40%) patients. Sixty (17%) patients had LAA and 27 (8%) had AF. Patients with positive DWI findings were more likely to have unilateral weakness (odds ratio [OR]=2.2; 95% CI, 1.3 to 3.7), TIA duration >/=60 minutes (OR=2.6; 95% CI, 1.3 to 5.2), ABCD(2) >5 (OR=4.7; 95% CI, 2.0 to 11.0), LAA (OR=1.8; 95% CI, 1.0 to 3.1), and AF (OR=3.5; 95% CI, 1.5 to 8.0). During follow-up, 5 patients had a stroke within 7 days (absolute risk=1.5%, 95% CI, 0.3% to 2.7%), and 10 had a stroke within 3 months (absolute risk=2.9%; 95% CI, 1.1% to 4.7%). All early strokes but 1 occurred in patients with positive DWI findings. ABCD(2) score and positive DWI findings were associated with an increased 7-day and 3-month risk of stroke. At 3 months, ABCD(2) score >5 (hazard ratio=10.1; 95% CI, 1.1 to 93.4), positive DWI result (hazard ratio=8.7; 95% CI, 1.1 to 71.0), and LAA (hazard ratio=3.4; 95% CI, 1.0 to 11.8) were independently associated with an increased risk of stroke. There was no association with AF.


CONCLUSIONS
Taking DWI and TIA etiology into account in addition to the ABCD(2) score improves the prediction of the early risk of stroke after TIA.
Calvet
David
D
Service de Neurologie, Hôpital Sainte-Anne, 1 rue Cabanis, 75014 Paris, France.
Touzé
Emmanuel
E
Oppenheim
Catherine
C
Turc
Guillaume
G
Meder
Jean-François
JF
Mas
Jean-Louis
JL
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology*; D049292:Leukoaraiosis / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology