title: Prediction of major vascular events in patients with transient ischemic attack or ischemic stroke: a comparison of 7 models.
abstract: OBJECTIVE
  In patients with a recent TIA or minor stroke, prediction of long-term risk of major vascular events is important, but difficult. We aimed to study the external validity of currently available prediction models.
  
  
  METHODS
  We validated predictions from 3 population-based models (Framingham, SCORE, and INDIANA project) and 4 stroke cohort-based models (Stroke Prognosis Instrument II, Oxford TIA, Dutch TIA study, and the ABCD(2) study) in an independent cohort of patients with a recent TIA or minor stroke. The validation cohort consisted of 592 patients with TIA or minor stroke, with a mean follow-up of 2 years. The primary outcome was the 2-year risk of the composite outcome event of nonfatal stroke, myocardial infarction, or vascular death. We used calibration graphs and c-statistics to evaluate the 7 models.
  
  
  RESULTS
  The 2-year risk of the primary outcome event was 12%. Calibration was adequate for stroke population-based studies. After adjustment for baseline risk and for prevalence of risk factors, calibration was adequate for the Dutch TIA, the ABCD(2), and Stroke Prognosis Instrument II models. Discrimination ranged from 0.61 to 0.68.
  
  
  CONCLUSIONS
  Discrimination was poor for all currently available risk prediction models for patients with a recent TIA or minor stroke, indicating the need for stronger predictors. Clinical usefulness may be best for the ABCD(2) model, which had a limited number of easily obtainable variables, a reasonable c-statistic (0.64), and good calibration.
authors.affiliation: Departments of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands. a.wijnhoud@erasmusmc.nl
authors.forename: Annemarie D
authors.initials: AD
authors.lastname: Wijnhoud
authors.forename: Lisette
authors.initials: L
authors.lastname: Maasland
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*