From clinical to tissue-based dual TIA Validation and refinement of ABCD3-I score
From clinical to tissue-based dual TIA Validation and refinement of ABCD3-I score
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DOI：
10.1212/wnl.0000000000001444
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发表时间：
2015-04-07
期刊：
影响因子：
9.9
通讯作者：
Liu, Xinfeng
中科院分区：
文献类型：
--
作者：
Dai, Qiliang;Sun, Wen;Liu, Xinfeng
目的：研究是否双重组织定义的缺血发作，定义为多个扩散加权成像病变的不同年龄和/或动脉领域（双重DWI），是一个独立的和更强的预测90天中风比双重临床TIA（双重TIA）。方法：连续性患者临床定义的TIA入组，并在3天内进行临床和MRI评估。ABCD临床因素，双TIA，双DWI的预测能力进行了评估，通过多变量logistic regression.Results：在658例患者中，谁被纳入研究，并完成了90天的随访，共有70例（10.6%）经历了随后的中风90天。多变量logistic回归分析表明，双重DWI是后续卒中的独立预测因子（比值比4.64，95%置信区间2.15-10.01），而双重TIA不是（比值比1.18，95%置信区间0.69-2.01）。当ABCD 3-I评分中的双TIA项目被双DWI取代时，C统计量更高（0.759 vs 0.729，p = 0.035）。90天卒中风险的净重新分类值也得到改善（连续净重新分类改善0.301，p = 0.017）。结论：双重DWI独立预测TIA患者未来卒中。一种新的ABCD 3-I评分与双重DWI而不是双重临床TIA可能会改善TIA后早期卒中风险的风险分层。
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).Conclusion: 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.