High-Risk ABCD² Scores May Predict Risk for Stroke After TIA

Patients with high-risk ABCD² scores face significantly elevated risks for long-term stroke and mortality following a transient ischemic attack (TIA), according to study findings published in Neurology.

The long-term connection between TIA and stroke remains poorly understood. Therefore, researchers aimed to assess the long-term risk of ischemic stroke following a TIA, using the ABCD² score as a predictive tool. Additionally, they sought to identify key factors that influence stroke occurrence after a TIA.

The researchers conducted a nationwide cohort study evaluating data collected from the Danish Stroke Registry between 2014 and 2020 of 21,433 patients with first-time TIA aged 18 and older. Patients were categorized into 2 groups based on a modified ABCD² score: high-risk (≥4 points) and low-risk (<4 points), which assigned points for age (≥60 years), hypertension, clinical features such as unilateral weakness or speech disturbances, and diabetes.

At baseline, high-risk patients were older (median age, 77.5 years vs 70.3 years), more likely to be women (53.1%), and had a higher prevalence of comorbidities such as atrial fibrillation (23.4% vs 9.9%), diabetes (37.7% vs 8.6%), and chronic kidney disease (11.3% vs 3.6%). These patients were also more frequently prescribed antiplatelet therapy, anticoagulants, and cholesterol-lowering medications.

Over a median follow-up of approximately 3 years, the cumulative incidence of ischemic stroke was 6.0% in the high-risk group compared with 4.2% in the low-risk group. Patients at high risk had a 60% higher likelihood of stroke (hazard ratio [HR], 1.56; 95% CI, 1.21-2.00).

Factors significantly associated with higher stroke risk included age ≥60 years (HR, 2.21; 95% CI, 1.76-2.78), current smoking (HR, 1.37; 95% CI, 1.13-1.65), chronic kidney disease (HR, 1.39; 95% CI, 1.01-1.90), and peripheral artery disease (HR, 1.53; 95% CI, 1.09-2.14).

In addition to elevated stroke risk, high-risk patients had substantially higher all-cause mortality rates within 3 years (28.9% vs 10.3%, HR, 3.16; 95% CI, 2.80-3.58).

The study’s observational nature and lack of symptom duration data limit its ability to draw causal conclusions.

“This study suggests the necessity to improve the preventive interventions, including evidence-based antithrombotic strategies, especially for the high-risk ABCD2 score group,” the researchers concluded.

Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.