Improving the Prediction of Stroke or Death After Transient Ischemic Attack (TIA) by Adding Diffusion-weighted Imaging Lesions and TIA Etiology to the ABCD2 Score

The present study investigated the addition of transient ischemic attack (TIA) etiology and diffusion-weighted imaging (DWI) to the ABCD2 score, creating the ABCDE+ score, to improve the predictive ability of stroke risk or death at 6 months after TIA. We performed a cohort study of 150 consecutive patients with TIA. All patients underwent DWI and all had an etiologic workup and were followed up for 6 months. The area under the receiver operating characteristic curve (AUC) was used to compare the scores' ability to predict the outcome of stroke or death. Multivariate Cox regression analysis was performed to evaluate the association between the measured variables and subsequent stroke or death. Thirty patients (20%) experienced future stroke, and 12 patients (8%) died within the 6-month follow-up. A comparison of AUCs demonstrated the superiority of the ABCDE+ score over the ABCD2 score for predicting stroke (0.64 vs 0.60) and for predicting death (0.62 vs 0.56). ABCD2 score >4, ABCDE+ score >6, large-artery disease, and lesions detected on DWI were found to be independent predictors of future stroke, and ABCDE+ score >6, age, and heart disease were independent predictors of death. We conclude that incorporating DWI positivity and etiology of TIA into the ABCD2 score can improve the ability to predict stroke and death within 6 months after TIA.