[Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients]. / Ausencia de utilidad de la escala clínica ABCD en el riesgo de infarto cerebral precoz en pacientes con accidente isquémico transitorio.

BACKGROUND AND OBJECTIVE: Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model. PATIENTS AND METHOD: We validated the ABCD score (age > or = 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes > or = 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. RESULTS: A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)]. CONCLUSIONS: Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies.

Ausencia de utilidad de la escala clínica ABCD en el riesgo de infarto cerebral precoz en pacientes con accidente isquémico transitorio / Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients

Fundamento y objetivo: El riesgo de recurrencia precoz tras un ataque isquémico transitorio (AIT) es elevado. Recientemente se ha descrito una escala clínica (ABCD score) para predecir los pacientes con mayor riesgo de nuevos ictus dentro de los primeros 7 días de seguimiento. Validamos dicha escala en una población de pacientes con AIT atendidos en nuestro centro. Pacientes y método: Estudiamos a 325 pacientes con AIT consecutivos. En todos ellos se cuantificó la escala ABCD, que tiene una puntuación máxima de 6 puntos (edad >= 65 años = 1; hipertensión arterial = 1; síntomas clínicos: paresia unilateral = 2; alteración del lenguaje = 1; duración de los síntomas: >= 60 min = 2; 10-59 min = 1; < 10 min = 0). Además se recogieron datos clínicos, de neuroimagen y de ultrasonografía de troncos supraaórticos y transcraneal. Resultados: Durante la primera semana de seguimiento, 16 (4,9%) pacientes sufrieron un infarto cerebral. Seis de 16 accidentes vasculares cerebrales (37,5%) tuvieron lugar en 115 (35,4%) pacientes con una escala igual o mayor de 5, mientras que el riesgo a los 7 días fue de 4,8% (IC del 95%, 2,04-7,56) en 210 (63,5%) pacientes con un valor inferior a 5. El análisis multivariante (regresión de Cox) identificó únicamente la etiología aterotrombótica como predictor independiente de recurrencia de ictus a los 7 días (razón de riesgos = 5,66; intervalo de confianza [IC] del 95%, 2,06-15,57; p = 0,001). Conclusiones: El riesgo de infarto cerebral precoz de los pacientes con un AIT no puede establecerse únicamente con variables clínicas, sino que es necesario un estudio etiológico exhaustivo y precoz que incluya un estudio ultrasonográfico tanto de los troncos supraaórticos como de la circulación intracraneal, para detectar a los pacientes en mayor riesgo de recurrencia e iniciar las medidas terapéuticas más adecuadas

Background and objective: Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model. Patients and method: We validated the ABCD score (age >= 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes >= 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded. Results: A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)]. Conclusions: Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies