Predicting long-term cardiovascular events after transient ischemic attacks: Carotid artery intima-media thickness or ABCD2 score or both?

Abstract

Background:Patients who experienced transient ischemic attack (TIA) are at high-risk for cardiovascular events. This study aims to evaluate diagnostic value of carotid artery intima-media thickness (CIMT) and ABCD2 score for predicting cardiovascular events in long-term follow-up after TIA. We prospectively included sixty patients with TIA who admitted to hospital from March 2016 to August 2016.Methods:Duplex ultrasonography of internal carotid arteries was performed. ABCD2 scores were evaluated for each patient. At a median follow-up of 20 months, patients were asked about new cardiovascular events. We used IBM SPSS software version 22.0 with Chi-squared, t-test, ANOVA, receiver operating characteristic, and area under the curve (AUC) analysis for our work.Results:Sensitivity and negative predictive value of the combined score (ABCD2+CIMT) was the highest (96.3% and 90.9%, respectively), and the specificity and positive predictive value of the CIMT were the highest (57.5% and 63.1%, respectively) to predict cardiovascular events in long-term.Conclusion:Compared to ABCD2 score, CIMT proved to be more accurate to predict cardiovascular events in long-term follow-ups (AUC = 0.736 vs. AUC = 0.640). However, adding CIMT value to ABCD2 score was even better (AUC = 0.750). Therefore, CIMT measurement in the ABCD2 score after TIA enables prediction of long-term cardiovascular events.

Clinical Risk Score for Predicting Recurrence Following a Cerebral Ischemic Event

“…For example, one study (72) showed that including CRP measurements in the acute phase to ABCD 2 improved the AUC significantly, but the TIA patient sample size was small and lacked validation. Other studies have also shown that adding parameters like DWI findings alone (44), brain infarction on DWI or CT (46), carotid imaging (at least 50% stenosis) and abnormal DWI (48), etiology and DWI (43, 71, 73), CT or transcranial Doppler (74), or carotid artery intima-media thickness (75) to ABCD 2 increase the c-statistics/AUC of ABCD 2 significantly. But many of these predictive models lack validation in large size cohorts.…”

Synthetic role of miR‐200b‐3p, ABCD2 score, and carotid ultrasound in the prediction of cerebral infarction in patients with transient ischemic attack

“…Furthermore, ABCD 2 score has also been proposed as a useful tool to predict the occurrence of short‐term CI after TIA onset (Johnston et al., 2007). Until recently, the ABCD 2 score was the most widely used tool in predicting the occurrence of CI in clinical TIA patients (Cutting et al., 2016; Giles et al., 2017); however, its sensitivity and accuracy are still suboptimal in the short term of TIA (Khorvash et al., 2018). Thus, the methods to predict the risk of CI in TIA patients still need improvement.…”

“…Until recently, the ABCD 2 score was the most widely used tool in predicting the occurrence of CI in clinical TIA patients (Cutting et al, 2016;Giles et al, 2017); however, its sensitivity and accuracy are still suboptimal in the short term of TIA (Khorvash et al, 2018).…”