Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD
2
Score
Authors: Jing Jing , Suo Yue , Wang Anxin , Zuo Yingting , Jiang Yong , Liu Liping , Zhao Xingquan , Wang Yilong , Li Zixiao , Li Hao , Meng Xia , Wang Yongjun , Li Jilai , Wu Jian , Zhang Mei , He Maolin , Gong Tao , Ouyang Quping , Huang Guang , Yu Fengchun , Wang Chenlong , Zhang Jinli , Wu Wenqing , Wang Yi , Yu Yaoyu , Zhang Meiyun , An Zhongping , Liu Junyan , Shi Wanying , Lu Baoquan , Geng Lijun , Wang Shujuan , Zhang Xu , Liu Ruifang , Zhao Fengli , Lin Jie , Liu Xinping , Sun Xuebing , Li Tianyuan , Wang Youming , He Xinxia , Yuan Weiqiang , Dou Ronghua , Liu Lihai , Wang Yanling , Zhang Junling , Du Haisong , Wei Yuqing , Wang Cunrui , Wang Limin , Zou Yu’an , Chen Xiaofei , Hu Fengyun , Liu Jinfeng , Zhao Lili , He Fanping , Wang Xingchen , Zhao Qingwei , Li Xiaohong , Zhao Jun , Xia Zhangyong , Li Hongjin , Yan Mingzong , Zhang Guiru , Liang Hui , Liu Yunlin , Xu Jun , Wang Runqing , Han Yuhui , Meng Xianghong , Li Mingzhen , Wang Ting , Han Xinsheng , Zhang Hongtian , Ma Congmin , Xue Wenjun , Wang Chun , Fang Yan , Liu Gexia , Wang Jianfeng , Ma Qiang , Li Xiaohong , Zheng Wenxu , Chi Haitao , Gao Lianbo , Zhou Jin , Chen Huisheng , Feng Juan , Xiao Hongbo , Xiao Lijun , Yang Yi , Li Guozhong , Zhu Yulan , Wang Lihua , Yang Yindong , Qiu Xuerong , Gong Xuhai , Chen Guohua , Peng Xiaoxiang , Liu Qunhui , Gong Shiping , Zhou Hongbin , Li Haipeng , You Yong , Lin Jinsheng , Xu Yun , Sheng Lei , Zhao Heqing , Zhuang Aixia , Ke Kaifu , Fang Qi , Dong Zhengxie , Cui Guiyun , Geng Deqin , Rong Liangqun , Shi Junfeng , Yu Ming , Xu Jun , Geng Yu , Luo Benyan , Cai Xueli , Zhou Jun , Wu Yi , Tang Weiguo , Wang Zhimin , Chen Yangmei , Wang Yanjiang , Chen Kangning , Wu Shizheng , Bu Wenguang , Cheng Xiaohua , Lu Zhengqi , Xu An’ding , Yin Jia , Cai Jifu , Guo Yi , Wu Jun , Li Lvli , Pan Li , Wang Yinzhou , Wang Ning , Niu Jianping , Li Qing , Wang Hong , Li Hongyan , Zhang Xiaoying , Zhan Liping , Chen Yongming , Wang Baojun , Wu Li’e , Liu Li , Zhao Yanru , Wu Yingchun , Zhu Runxiu , Du Yanhui , Wen Yongxia , Tian Ye , Wu Songdi , Qu Yongcai , Wu Yuncheng , Liu Jianren , Dong Qiang , Bai Qingke , Zhao Yuwu , Chen Xu , He Chaoming , Ren Lijie , Qiu Weiwen , Yao Shufang , Sun Xuwen , Zhang Hainan , Li Weirong , Gao Ligong , Chen Xianglin , Li Jianhua , Shi Qiuyan , Wang Yan , Zhao Mingzhi , Zeng Jinsheng , Wang Liping , Wang Wei , Qiu Feng , Li Zhaochen , Zhao Liang , Chen Tianbao , Xia Lei , Yang SuYun , Han Yazhou , Liu Liyan , Wu Xinxiao , Jiang Beihai , Li Lizhong , Lou Weidong , Shen Xiaoqian , Zhang Ping , Lan Weiming , Zheng Aihu , Bai Qifu , Luan Lifang , Chen Lin , Yan Liqing , Wang Yanxia , Huang Xuerong , Chai Xiangting , Liu Yanshu , You Liangjun , Yang Hongqin , Li Dongfang , Wang Huijuan , Gui Linying , Wu Aisheng , Zhang Jianling , Wang Dengling , Zhang Qinghua , He Yunhong , Guo Ruiyou , Teng Jijun , Lou Ping 
Published: May 2021

Background and Purpose:

Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD
2
score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD
2
score.

Methods:

We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD
2
score (low risk, 0–3; moderate risk, 4–5; and high risk, 6–7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence.

Results:

Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD
2
score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200–2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042–1.687]) but not in the high-risk group (
P
>0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group.

Conclusions:

Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD
2
score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.