title: Predictive value of brain and vascular imaging including intracranial vessels in transient ischaemic attack patients: external validation of the ABCD3-I score.
abstract: OBJECTIVE
  Recently, brain and vascular imaging have been added to clinical variables to identify patients with transient ischaemic attack (TIA) with a high risk of stroke recurrence. The aim of our study was to externally validate the ABCD3-I score and the same score taking into account intracranial circulation.
  
  
  METHODS
  We analyzed data from 1137 patients with TIA from the PROMAPA study who underwent diffusion-weighted magnetic resonance imaging (DWI) within 7 days of symptom onset. Clinical variables and diagnostic work-up were recorded prospectively. The end-points were subsequent stroke at 7 and 90 days follow-up.
  
  
  RESULTS
  A total of 463 (40.7%) subjects fulfilled all inclusion criteria. During follow-up, eight patients (1.7%) had a stroke within 7 days, and 14 (3.1%) had a stroke within 3 months. In the Cox proportional hazard multivariate analyses, the combination of large-artery atherosclerosis and positive DWI remained as independent predictors of stroke recurrence at 7- and 90-day follow-up [HR 8.23, 95% confidence interval (CI) 2.89-23.46, P < 0.001]. The ABCD3-I score was a powerful predictor of subsequent stroke. The area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) at 7 days and 0.69 (95% CI 0.53-0.85) at 90 days. When we include intracranial vessel disease in the score, the area under the curve increases but the difference observed was non-significant.
  
  
  CONCLUSIONS
  The inclusion of vascular and neuroimaging information to clinical scales (ABCD3-I score) provides important prognostic information and also helps management decisions, although it cannot give a complete distinction between high-risk and low-risk groups.
authors.affiliation: Stroke Unit, Hospital Universitari Arnau de Vilanova, Lleida, Spain. fpurroygarcia@gmail.com
authors.forename: F
authors.initials: F
authors.lastname: Purroy
authors.forename: P E
authors.initials: PE
authors.lastname: Jiménez-Caballero
authors.forename: G
authors.initials: G
authors.lastname: Mauri-Capdevila
authors.forename: M J
authors.initials: MJ
authors.lastname: Torres
authors.forename: A
authors.initials: A
authors.lastname: Gorospe
authors.forename: J M
authors.initials: JM
authors.lastname: Ramírez Moreno
authors.forename: N P
authors.initials: NP
authors.lastname: de la Ossa
authors.forename: D
authors.initials: D
authors.lastname: Cánovas
authors.forename: J
authors.initials: J
authors.lastname: Arenillas
authors.forename: J
authors.initials: J
authors.lastname: Alvarez-Sabín
authors.forename: P
authors.initials: P
authors.lastname: Martínez Sánchez
authors.forename: B
authors.initials: B
authors.lastname: Fuentes
authors.forename: R
authors.initials: R
authors.lastname: Delgado-Mederos
authors.forename: J
authors.initials: J
authors.lastname: Martí-Fàbregas
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez Campello
authors.forename: J
authors.initials: J
authors.lastname: Masjuán
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D063189:Symptom Assessment; D014463:Ultrasonography