DWI Lesions and TIA Etiology Improve the Prediction of Stroke After TIA

Background and Purpose-The ABCD(2) score has been shown to predict the early risk of stroke after transient ischemic attack (TIA). The additional predictive value of diffusion-weighted imaging (DWI) and TIA etiology is not well known. Methods-From January 2003 to June 2007, 343 consecutive patients (mean +/- SD age, 62.4 +/- 15.4 years) with TIA were admitted to our stroke unit. Most (339) patients underwent DWI and all had an etiologic work-up and were followed up for 3 months. The predictive value of the ABCD(2) score, positive DWI findings, large-artery atherosclerosis (LAA), and atrial fibrillation (AF) with respect to occurrence of ischemic stroke at 1 week and 3 months was assessed. Results-DWI was positive in 136 (40%) patients. Sixty (17%) patients had LAA and 27 (8%) had AF. Patients with positive DWI findings were more likely to have unilateral weakness (odds ratio [ OR] = 2.2; 95% CI, 1.3 to 3.7), TIA duration >= 60 minutes (OR = 2.6; 95% CI, 1.3 to 5.2), ABCD(2) > 5 (OR = 4.7; 95% CI, 2.0 to 11.0), LAA (OR = 1.8; 95% CI, 1.0 to 3.1), and AF (OR = 3.5; 95% CI, 1.5 to 8.0). During follow-up, 5 patients had a stroke within 7 days (absolute risk = 1.5%, 95% CI, 0.3% to 2.7%), and 10 had a stroke within 3 months (absolute risk = 2.9%; 95% CI, 1.1% to 4.7%). All early strokes but 1 occurred in patients with positive DWI findings. ABCD(2) score and positive DWI findings were associated with an increased 7-day and 3-month risk of stroke. At 3 months, ABCD(2) score > 5 (hazard ratio = 10.1; 95% CI, 1.1 to 93.4), positive DWI result (hazard ratio = 8.7; 95% CI, 1.1 to 71.0), and LAA (hazard ratio = 3.4; 95% CI, 1.0 to 11.8) were independently associated with an increased risk of stroke. There was no association with AF. Conclusions-Taking DWI and TIA etiology into account in addition to the ABCD(2) score improves the prediction of the early risk of stroke after TIA. (Stroke. 2009; 40: 187-192.)