From clinical to tissue-based dual TIA: Validation and refinement of ABCD3-I score.
OBJECTIVE
To investigate whether dual tissue-defined ischemic attacks, defined as multiple diffusion-weighted imaging lesions of different age and/or arterial territory (dual DWI), are an independent and stronger predictor of 90-day stroke than dual clinical TIAs (dual TIA).


METHODS
Consecutive patients with clinically defined TIA were enrolled and assessed clinically and by MRI within 3 days. The predictive ability of the ABCD clinical factors, dual TIA, and dual DWI was evaluated by means of multivariate logistic regression.


RESULTS
Among 658 patients who were included in the study and completed 90 days of follow-up, a total of 70 patients (10.6%) experienced subsequent stroke by 90 days. Multivariate logistic regression indicated that dual DWI was an independent predictor for subsequent stroke (odds ratio 4.64, 95% confidence interval 2.15-10.01), while dual TIA was not (odds ratio 1.18, 95% confidence interval 0.69-2.01). C statistics was higher when the item of dual TIA in ABCD3-I score was replaced by dual DWI (0.759 vs 0.729, p = 0.035). The net reclassification value for 90-day stroke risk was also improved (continuous net reclassification improvement 0.301, p = 0.017).


CONCLUSIONS
Dual DWI independently predicted future stroke in patients with TIA. A new ABCD3-I score with dual DWI instead of dual clinical TIA may improve risk stratification for early stroke risk after TIA.
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Qiliang
Q
Dai
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Wen
W
Sun
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Yunyun
Y
Xiong
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Graeme J
GJ
Hankey
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Lulu
L
Xiao
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Wusheng
W
Zhu
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Minmin
M
Ma
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Wenhua
W
Liu
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Dezhi
D
Liu
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Qiankun
Q
Cai
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Yunfei
Y
Han
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Lihui
L
Duan
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Xiangliang
X
Chen
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China.
Gelin
G
Xu
From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China. xfliu2@vip.163.com.
Xinfeng
X
Liu
D000368:Aged; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis*; D013997:Time Factors