Background and Purpose-A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score Ͻ4 reportedly indicates minimal short-term stroke risk. We evaluated this scoring system in an independent population. Methods-This was a prospective study of TIA patients (diagnosed by a neurologist using the classic Ͻ24-hour definition) hospitalized Ͻ48 hours from symptom onset. The primary outcome assessment consisted of dichotomization of patients into 2 groups. The high-risk group included patients with stroke or death within 90 days, Ն50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWIϩ or DWIϪ. Results-Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with Ն50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trendϭ0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWIϩ, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trendϭ0.24). Conclusions-Although the ABCD score has some predictive value, patients with a score Ͻ4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.

Background and Purpose-Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is a marker of unstable atherosclerotic plaque, and is predictive of both primary and secondary stroke in population-based studies. Methods-We conducted a prospective study of patients with acute TIA who presented to the ED. Clinical risk scoring using the ABCD 2 score was determined and Lp-PLA 2 mass (LpPLA 2 -M) and activity (LpPLA 2 -A) and high-sensitivity C-reactive protein (CRP) were measured. The primary outcome measure was a composite end point consisting of stroke or death within 90 days or identification of a high-risk stroke mechanism requiring specific early intervention (defined as Ն50% stenosis in a vessel referable to symptoms or a cardioembolic source warranting anticoagulation