High-Risk ABCD2 Scores Linked to Increased Long-Term Stroke Risk After TIA : Study
Researchers have found that with high-risk ABCD2 scores, the long-term risk of ischemic stroke after a transient ischemic attack (TIA) is significantly increased. It is well known and established that TIA boosts the short-term risk of stroke but long-term data on this issue have not been available. A recent study was thus conducted by Katia and colleagues which was published in the journal Neurology.
The study was conducted using data from the Danish Stroke Registry. The study population included patients aged 18 years or older who experienced a first-time TIA between 2014 and 2020. Patients were categorized into high-risk (ABCD2 score ≥4) and low-risk (ABCD2 score <4) groups.
The ABCD2 score incorporates age, hypertension, clinical features, and diabetes. Long-term outcomes were assessed at 3 years, particularly the cumulative incidence of stroke, and all-cause mortality at the end. Aalen-Johansen and Kaplan-Meier methods assessed long-term outcomes. Multivariate Cox regression models determined the factors associated with stroke risk over 3 years.
Of the 21,433 patients included, 1,280 (6.0%) were placed in the high-risk category, and 20,153 (94.0%) were placed in the low-risk category. There was also an important demographic difference: patients in the high-risk group were on average older, with a median age of 77.5 years compared with 70.3 in the low-risk group.
High-risk patients had a higher burden of comorbid conditions, including ischemic heart disease, heart failure, and atrial fibrillation and were more likely to take medications such as antiplatelet therapy, oral anticoagulants, and cholesterol-lowering drugs.
Key Findings
• Stroke Risk: The 3-year cumulative incidence of ischemic stroke was 6.0% (95% CI 4.6–7.5) in the high-risk group, compared to 4.2% (95% CI 3.9–4.5) in the low-risk group (p = 0.004).
• Mortality Rates: The 3-year cumulative all-cause mortality was significantly higher in the high-risk group (28.9%, 95% CI 26.1–31.7) than in the low-risk group (10.3%, 95% CI 9.9–10.8).
• Associated Factors: Age ≥60 years (HR 2.21), current smoking (HR 1.37), unilateral weakness (HR 1.25), peripheral artery disease (HR 1.53), and chronic kidney disease (HR 1.39) were independently associated with higher stroke risk.
The findings in this large population-based study showed that the high-risk ABCD2 score was significantly associated with increased long-term risk of ischemic stroke after TIA. It highlights the importance of early identification and management of at-risk individuals to prevent further strokes and improve health outcomes in the long run.
Reference:
Al-Chaer, K., Alhakak, A., Vinding, N. E., Butt, J. H., Karacan, M. N., Johnsen, S. P., Kruuse, C., Schou, M., Torp-Pedersen, C., Køber, L., & Fosbøl, E. (2024). Incident stroke after first-time TIA according to ABCD 2 score: A nationwide cohort study. Neurology, 103(12). https://doi.org/10.1212/wnl.0000000000210053
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