Qiliang Dai1, Wen Sun1, Yunyun Xiong1, Graeme J Hankey1, Lulu Xiao1, Wusheng Zhu1, Minmin Ma1, Wenhua Liu1, Dezhi Liu1, Qiankun Cai1, Yunfei Han1, Lihui Duan1, Xiangliang Chen1, Gelin Xu1, Xinfeng Liu2. 1. From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China. 2. From the Department of Neurology (Q.D., W.S., Y.X., L.X., W.Z., M.M., W.L., D.L., L.D., X.C., G.X., X.L.), Jinling Hospital, Medical School of Nanjing University, Nanjing, China; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Australia; Department of Neurology (Q.C.), the Second Affiliated Hospital of Fujian Medical University, Fujian, China; and Department of Neurology (Y.H.), Jinling Hospital, Southern Medical University, Nanjing, China. xfliu2@vip.163.com.
Abstract
OBJECTIVE: To investigate whether dual tissue-defined ischemic attacks, defined as multiple diffusion-weighted imaging lesions of different age and/or arterial territory (dual DWI), are an independent and stronger predictor of 90-day stroke than dual clinical TIAs (dual TIA). METHODS: Consecutive patients with clinically defined TIA were enrolled and assessed clinically and by MRI within 3 days. The predictive ability of the ABCD clinical factors, dual TIA, and dual DWI was evaluated by means of multivariate logistic regression. RESULTS: Among 658 patients who were included in the study and completed 90 days of follow-up, a total of 70 patients (10.6%) experienced subsequent stroke by 90 days. Multivariate logistic regression indicated that dual DWI was an independent predictor for subsequent stroke (odds ratio 4.64, 95% confidence interval 2.15-10.01), while dual TIA was not (odds ratio 1.18, 95% confidence interval 0.69-2.01). C statistics was higher when the item of dual TIA in ABCD3-I score was replaced by dual DWI (0.759 vs 0.729, p = 0.035). The net reclassification value for 90-day stroke risk was also improved (continuous net reclassification improvement 0.301, p = 0.017). CONCLUSION: Dual DWI independently predicted future stroke in patients with TIA. A new ABCD3-I score with dual DWI instead of dual clinical TIA may improve risk stratification for early stroke risk after TIA.
OBJECTIVE: To investigate whether dual tissue-defined ischemic attacks, defined as multiple diffusion-weighted imaging lesions of different age and/or arterial territory (dual DWI), are an independent and stronger predictor of 90-day stroke than dual clinical TIAs (dual TIA). METHODS: Consecutive patients with clinically defined TIA were enrolled and assessed clinically and by MRI within 3 days. The predictive ability of the ABCD clinical factors, dual TIA, and dual DWI was evaluated by means of multivariate logistic regression. RESULTS: Among 658 patients who were included in the study and completed 90 days of follow-up, a total of 70 patients (10.6%) experienced subsequent stroke by 90 days. Multivariate logistic regression indicated that dual DWI was an independent predictor for subsequent stroke (odds ratio 4.64, 95% confidence interval 2.15-10.01), while dual TIA was not (odds ratio 1.18, 95% confidence interval 0.69-2.01). C statistics was higher when the item of dual TIA in ABCD3-I score was replaced by dual DWI (0.759 vs 0.729, p = 0.035). The net reclassification value for 90-day stroke risk was also improved (continuous net reclassification improvement 0.301, p = 0.017). CONCLUSION: Dual DWI independently predicted future stroke in patients with TIA. A new ABCD3-I score with dual DWI instead of dual clinical TIA may improve risk stratification for early stroke risk after TIA.