Background: It has been suggested that scores for risk stratification of TIA patients might not identify patients with carotid stenosis or atrial fibrillation (AF) and that this might undermine the usefulness of such scores. Methods: In patients with TIA in the Oxford Vascular Study, we studied the associations between ABCD and ABCD2 scores, the presence of ≧50% ipsilateral carotid stenosis or AF, and the risk of stroke at 7 days. Results: Among 285 TIA patients (from 559 referrals of possible TIA), 69 (24.2%) had either ≧50% carotid stenosis (n = 29) or AF (n = 42), or both (n = 2). Although the ABCD and ABCD2 scores were highly predictive of stroke at 7 days (p < 0.0001), there was no clear relationship between either score and the prevalence of ≧50% carotid stenosis or AF. However, the scores did predict the 7-day stroke risk in patients with these pathologies: ABCD score (trend – p = 0.05); ABCD2 (trend – p = 0.03). Five of the 6 patients with AF or symptomatic stenosis who had a stroke within 7 days of their TIA had an ABCD score of ≧5 and all 6 had an ABCD2 score of ≧4. Conclusions: The ABCD and ABCD2 risk scores appear to identify patients with ≧50% carotid stenosis or AF who are at high risk of stroke. However, these findings should be interpreted with caution due to the small number of outcomes among these subgroups, and further validations are necessary.

1.
Hankey GJ, Slattery JM, Warlow CP: Transient ischaemic attacks: which patients are at high (and low) risk of serious vascular events? J Neurol Neurosurg Psychiatry 1992;55:640–652.
2.
Kernan WN, Viscoli CM, Brass LM, Makuch RW, Sarrel PM, Roberts RS, Gent M, Rothwell P, Sacco RL, Liu RC, Boden-Albala B, Horwitz RI: The stroke prognosis instrument II (SPI II): a clinical prediction instrument for patients with transient ischaemia and non-disabling ischaemic stroke. Stroke 2000;31:456–462.
3.
Rothwell PM, Warlow CP: Prediction of benefit from carotid endarterectomy in individual patients: a risk modeling study. Lancet 1999;353:2105–2110.
4.
Rothwell PM, Mehta Z, Howard SC, Gutnikov SA, Warlow CP: From subgroups to individuals: general principles and the example of carotid endartectomy. Lancet 2005;365:256–265.
5.
Johnston SC, Gress DR, Browner WS, Sidney S: Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901–2906.
6.
Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z: A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005;366:29–36.
7.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S: Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007;369:283–292.
8.
Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE: Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke 2006;37:1710–1714.
9.
Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, Gutnikov SA, Edwards P, Mant D, Sackley CM, Farmer A, Sandercock PA, Dennis MS, Warlow CP, Bamford JM, Anslow P; Oxford Vascular Study: Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925–1933.
10.
Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JN, Bull LM, Welch SJ, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z; Oxford Vascular Study: Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005;366:1773–1783.
11.
Rothwell PM: Incidence, risk factors and prognosis of stroke and TIA: the need for high-quality, large-scale epidemiological studies and meta-analyses. Cerebrovasc Dis 2003;16(suppl 3):2–10.
12.
Coull AJ, Lovett JK, Rothwell PM: Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ 2004;328:326–328.
13.
Hill MD, Yiannakoulias N, Jeerakathil T, Tu JV, Svenson LW, Schopflocher DP: The high risk of stroke immediately after transient ischemic attack: a population-based study. Neurology 2004;62:2015–2020.
14.
Johnston SC, Nguyen-Huynh MN, Schwarz ME, Fuller K, Williams CE, Josephson SA, Hankey GJ, Hart RG, Levine SR, Biller J, Brown RD Jr, Sacco RL, Kappelle LJ, Koudstaal PJ, Bogousslavsky J, Caplan LR, van Gijn J, Algra A, Rothwell PM, Adams HP, Albers GW: National Stroke Association guidelines for the management of transient ischemic attacks. Ann Neurol 2006;60:301–313.
15.
Fairhead JF, Rothwell PM: The need for urgency in identification and treatment of symptomatic carotid stenosis is already established. Cerebrovasc Dis 2005;19:355–358.
16.
Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJ; Carotid Endarterectomy Trialists Collaboration: Endarterectomy for symptomatic carotid stenosis in relation to clinical subgroups and timing of surgery. Lancet 2004;363:915–924.
17.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
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