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    Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study.

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    Authors
    Sheehan, Orla C
    Kyne, Lorraine
    Kelly, Lisa A
    Hannon, Niamh
    Marnane, Michael
    Merwick, Aine
    McCormack, Patricia M E
    Duggan, Joseph
    Moore, Alan
    Moroney, Joan
    Daly, Leslie
    Harris, Dawn
    Horgan, Gillian
    Williams, Emma B
    Kelly, Peter J
    Show allShow less
    Affiliation
    Neurovascular Clinical Science Unit, Mater University Hospital/University College Dublin, Ireland.
    Issue Date
    2010-05
    MeSH
    Aged
    Aged, 80 and over
    Atrial Fibrillation
    Carotid Stenosis
    Cohort Studies
    Early Diagnosis
    Female
    Follow-Up Studies
    Humans
    Ireland
    Ischemic Attack, Transient
    Male
    Middle Aged
    Predictive Value of Tests
    Prospective Studies
    Risk Factors
    Severity of Illness Index
    Stroke
    Show allShow less
    
    Metadata
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    Citation
    Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study. 2010, 41 (5):844-50 Stroke
    Journal
    Stroke; a journal of cerebral circulation
    URI
    http://hdl.handle.net/10147/127694
    DOI
    10.1161/STROKEAHA.109.571844
    PubMed ID
    20299667
    Abstract
    Transient ischemic attack (TIA) etiologic data and the ABCD(2) score may improve early stroke risk prediction, but studies are required in population-based cohorts. We investigated the external validity of the ABCD(2) score, carotid stenosis, and atrial fibrillation for prediction of early recurrent stroke after TIA.
    Patients with TIA in the North Dublin city population (N=294 529) were ascertained by using overlapping hospital and community sources. The relations between individual ABCD(2) items, carotid stenosis, atrial fibrillation, and early stroke were examined.
    In confirmed TIA cases (n=443), carotid stenosis predicted 90-day stroke (hazard ratio=2.56; 95% CI, 1.27 to 5.15, P=0.003). Stroke risk rose with increasing grade of carotid stenosis, ranging from 5.4% (95% CI, 3.3% to 8.7%) with <50% stenosis to 17.2% (95% CI, 9.7% to 29.7%) with severe stenosis/occlusion (hazard ratio=3.3; 95% CI, 1.5 to 7.4, P=0.002). In confirmed TIA cases (n=443), the ABCD(2) score performed no better than chance for prediction of 90-day stroke (c-statistic=0.55; 95% CI, 0.45 to 0.64), largely related to the 24.2% (8/33) of patients who experienced a recurrence and had low ABCD(2) scores (0-3). However, in nonspecialist-suspected TIA cases (n=700), the predictive utility improved for stroke at 28 (c-statistic=0.61; 95% CI, 0.50 to 0.72) and 90 (c-statistic=0.61; 95% CI, 0.52 to 0.71) days.
    In a population-based TIA cohort, significant predictive information was provided by carotid stenosis. The ABCD(2) score had predictive utility in patients with TIA suspected by nonspecialists. Low scores occurred in several patients with stroke recurrences, suggesting that caution is needed before using the score in isolation.
    Item Type
    Article
    Language
    en
    ISSN
    1524-4628
    ae974a485f413a2113503eed53cd6c53
    10.1161/STROKEAHA.109.571844
    Scopus Count
    Collections
    Beaumont Hospital

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