Prediction of Early Stroke Recurrence in Transient Ischemic Attack Patients from the PROMAPA Study: A Comparison of Prognostic Risk Scores
Por:
Purroy, F, Caballero, PEJ, Gorospe, A, Torres, MJ, Alvarez-Sabin, J, Santamarina, E, Martinez-Sanchez, P, Canovas, D, Freijo, MM, Egido, JA, Giron, JM, Ramirez-Moreno, JM, Alonso, A, Rodriguez-Campello, A, Casado, I, Delgado-Mederos, R, Marti-Fabregas, J, Fuentes, B, Silva, Y, Quesada, H, Cardona, P, Morales, A, de la Ossa, N, Garcia-Pastor, A, Arenillas, JF, Segura, T, Jimenez, C, Masjuan, J
Publicada:
1 ene 2012
Resumen:
Background: Several clinical scales have been developed for predicting stroke recurrence. These clinical scores could be extremely useful to guide triage decisions. Our goal was to compare the very early predictive accuracy of the most relevant clinical scores [age, blood pressure, clinical features and duration of symptoms (ABCD) score, ABCD and diabetes (ABCD2) score, ABCD and brain infarction on imaging score, ABCD2 and brain infarction on imaging score, ABCD and prior TIA within 1 week of the index event (ABCD3) score, California Risk Score, Essen Stroke Risk Score and Stroke Prognosis Instrument II] in consecutive transient ischemic attack (TIA) patients. Methods: Between April 2008 and December 2009, we included 1,255 consecutive TIA patients from 30 Spanish stroke centers (PROMAPA study). A neurologist treated all patients within the first 48 h after symptom onset. The duration and typology of clinical symptoms, vascular risk factors and etiological work-ups were prospectively recorded in a case report form in order to calculate established prognostic scores. We determined the early short-term risk of stroke (at 7 and 90 days). To evaluate the performance of each model, we calculated the area under the receiver operating characteristic curve. Cox proportional hazards multi-variate analyses determining independent predictors of stroke recurrence using the different components of all clinical scores were calculated. Results: We calculated clinical scales for 1,137 patients (90.6%). Seven-day and 90-day stroke risks were 2.6 and 3.8%, respectively. Large-artery atherosclerosis (LAA) was observed in 190 patients (16.7%). We could confirm the predictive value of the ABCD3 score for stroke recurrence at the 7-day follow-up [0.66, 95% confidence interval (CI) 0.54-0.77] and 90-day follow-up (0.61, 95% CI 0.52-0.70), which improved when we added vascular imaging information and derived ABCD3V scores by assigning 2 points for at least 50% symptomatic stenosis on carotid or intracranial imaging (0.69, 95% CI 0.57-0.81, and 0.63, 95% CI 0.51-0.69, respectively). When we evaluated each component of all clinical scores using Cox regression analyses, we observed that prior TIA and LAA were independent predictors of stroke recurrence at the 7-day follow-up [hazard ratio (HR) 3.97, 95% CI 1.91-8.26, p < 0.001, and HR 3.11, 95% CI 1.47-6.58, p = 0.003, respectively] and 90-day follow-up (HR 2.35, 95% CI 1.28-4.31, p = 0.006, and HR 2.20, 95% CI 1.15-4.21, p = 0.018, respectively). Conclusion: All published scores that do not take into account vascular imaging or prior TIA when identifying stroke risk after TIA failed to predict risk when applied by neurologists. Clinical scores were not able to replace extensive emergent diagnostic evaluations such as vascular imaging, and they should take into account unstable patients with recent prior transient episodes. Copyright (C) 2012 S. Karger AG, Basel
Filiaciones:
Purroy, F:
Univ Lleida, Hosp Univ Arnau de Vilanova Lleida, Dept Neurol, Stroke Unit,IRBLleida Res Inst, ES-25198 Lleida, Spain
Caballero, PEJ:
Hosp San Pedro de Alcantara Caceres, Dept Neurol, Caceres, Spain
Gorospe, A:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Torres, MJ:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Alvarez-Sabin, J:
Hosp Univ Vall DHebron, Dept Neurol, Stroke Unit, Barcelona, Spain
Santamarina, E:
Hosp Univ Vall DHebron, Dept Neurol, Stroke Unit, Barcelona, Spain
Martinez-Sanchez, P:
Univ Autonoma Madrid, La Paz Univ Hosp, IdiPAZ Res Inst, Stroke Ctr,Dept Neurol, Madrid, Spain
Canovas, D:
Hosp Parc Tauli, Dept Neurol, Sabadell, Spain
Freijo, MM:
Hosp Basurto, Dept Neurol, Bilbao, Spain
Egido, JA:
Hosp Clin San Carlos, Dept Neurol, Madrid, Spain
Giron, JM:
Hosp Jerez, Jerez de la Frontera, Spain
Ramirez-Moreno, JM:
Hosp Univ Infanta Cristina, Dept Neurol, Badajoz, Spain
Alonso, A:
Hosp Univ Ramon y Cajal, Stroke Unit, Madrid, Spain
Rodriguez-Campello, A:
Hosp Mar, Stroke Unit, Barcelona, Spain
Casado, I:
Hosp San Pedro de Alcantara Caceres, Dept Neurol, Caceres, Spain
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Dept Neurol, Barcelona, Spain
Fuentes, B:
Univ Autonoma Madrid, La Paz Univ Hosp, IdiPAZ Res Inst, Stroke Ctr,Dept Neurol, Madrid, Spain
Silva, Y:
Hosp Josep Trueta, Dept Neurol, Stroke Unit, Girona, Spain
Quesada, H:
Hosp Univ Bellvitge, Dept Neurol, Stroke Unit, Barcelona, Spain
Cardona, P:
Hosp Univ Bellvitge, Dept Neurol, Stroke Unit, Barcelona, Spain
Morales, A:
Hosp Univ Virgen de la Arrixaca, Dept Neurol, Murcia, Spain
de la Ossa, N:
Hosp Badalona Germans Trias & Pujol, Dept Neurol, Stroke Unit, Badalona, Spain
Garcia-Pastor, A:
Hosp Gen Univ Gregorio Maranon, Dept Neurol, Stroke Unit, Madrid, Spain
Arenillas, JF:
Univ Valladolid, Univ Hosp, Dept Neurol, Stroke Unit, Valladolid, Spain
Univ Valladolid, Univ Hosp, Dept Neurol, Stroke Program, Valladolid, Spain
Segura, T:
Hosp Univ Albacete, Dept Neurol, Albacete, Spain
Jimenez, C:
Hosp Univ Son Dureta, Dept Neurol, Palma de Mallorca, Spain
Masjuan, J:
Hosp Univ Ramon y Cajal, Stroke Unit, Madrid, Spain
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