London, United Kingdom 2013 7 Acute cerebrovascular events (ACE): TIA and minor strokes 9:30 - 9:40 Microalbuminuria could improve risk prediction of stroke in patients with TIA and minor stroke: the Prognostic Markers of TIA Evolution (ProMOTE) pilot study. W.D. Strain1, S Elyas2, K Gooding3, H Eastwood4, S Keenan5, J Stewart6, M.A. James7, A.C. Shore8 University of Exeter Medical School, Exeter, UNITED KINGDOM1,University of Exeter Medical School, Exeter, UNITED KINGDOM2, University of Exeter Medical School, Exeter, UNITED KINGDOM3, Royal Devon & Exeter Hospital, Exeter, UNITED KINGDOM4, Royal Devon & Exeter Hospital, Exeter, UNITED KINGDOM5, Royal Devon & Exeter Hospital, Ex-eter, UNITED KINGDOM6, Royal Devon & Exeter Hospital, Exeter, UNITED KINGDOM7, University of Exeter Medical School, Exeter, UNITED KINGDOM8 Background: Stroke is a leading cause of disability and mortality worldwide. Transient isch-aemic attacks (TIA) and minor strokes are important risk factors for recurrent strokes, with up to 23% of strokes being preceded by a TIA or minor stroke within 90 days. Current stroke prediction risk scores such as ABCD2, although widely used, lack optimal sensitivity and spec-ificity. Elevated urinary albumin excretion predicts cardiovascular disease, stroke and mortality in patients with hypertension, diabetes as well as the general population. In this pilot study we explored the role of urinary albumin:creatinine ratio (ACR) in improving risk prediction in pa-tients Cerebrovasc Dis 2013; 35 (suppl 3)1-854 103 with TIA and minor stroke. Methods: Basic demographics and ABCD2 score was recorded in 150 patients attending a daily stroke clinic with TIA or minor stroke. Urinary ACR was measured on a spot sample using a bench-top analyser. Patients were followed up at day 7, 30 and 90 to determine recurrent stroke , cardiovascular events, or death. Results: Nine patients had recurrent cerebrovascular events by day 7; 13 (9%) by day 90. There was no difference in baseline characteristics between those with and without events. ACR was higher in those who had events at day 7 (4.00 (95% CI 1.89-8.40) vs. 1.89 (1.58-2.25)mg/mmol respectively, p=0.03), and at day 90 (3.73 (2.12-6.56) vs. 1.85 (1.55-2.22) mg/mmol respec-tively; p=0.02). This was independent of age, sex, blood pressure and diabetes. Stratifying at an ACR of >3mg/mmol identified 27% “high risk participants”. These individuals had a 3.2 fold increased risk of having a further event compared to those with an ACR <3mg/mmol (p<0.04) Conclusion: After a TIA or minor stroke, ACR was higher in those who progressed to have further events within 7 and 90 days. Incorporation of urinary ACR from a single sample in the acute setting could improve the performance of predictive risk scores. This requires validation in a larger population. Biomarker All patients HR (95% CI) p TIA HR (95% CI) p Minor Stro-ke HR (95% CI) p Major Stroke HR (95% CI) p Fibrinogen 1.16(1.03-1.32) 0.017 1.26(0.90- 1.75) 0.174 1.13(0.94- 1.34) 0.189 1.16(0.91- 1.47) 0.235 Protein Z 0.96(0.85-1.08) 0.489 0.76(0.53- 1.09) 0.131 1.04(0.89- 1.23) 0.609 0.91(0.73- 1.13) 0.383 D-dimer 1.04(0.91-1.19) 0.531 1.04(0.75- 1.44) 0.819 1.03(0.85- 1.24) 0.789 1.00(0.79- 1.26) 0.986 Von Willebrand Factor 0.96(0.85-1.09) 0.514 0.94(0.65- 1.34) 0.720 0.94(0.79- 1.12) 0.515 0.91(0.74- 1.13) 0.414 P-selectin 1.07(0.95-1.20) 0.268 1.91(1.12- 3.25) 0.017 1.01(0.86- 1.19) 0.893 0.92(0.75- 1.12) 0.401 Thrombomodulin 1.00(0.91-1.10) 0.994 0.99(0.78- 1.24) 0.903 1.02(0.89- 1.17) 0.780 1.00(0.83- 1.20) 0.973 Brain Derived Neurotro-phic Factor 1.02(0.93-1.13) 0.624 1.11(0.88- 1.40) 0.371 0.98(0.86- 1.11) 0.738 1.03(0.85- 1.25) 0.744 C Reactive Protein 1.13(1.00-1.28) 0.042 1.02(0.78- 1.33) 0.876 1.09(0.93- 1.29) 0.290 1.58(0.92- 2.69) 0.094 Interleukin-6 1.09(0.98-1.21) 0.108 0.52(0.85- 1.35) 0.570 1.08(0.93- 1.24) 0.321 1.10(0.86- 1.41) 0.429 Tumour Necrosis Fac-tor- 1 0.99(0.89-1.09) 0.810 0.94(0.74- 1.16) 0.419 1.00(0.87- 1.16) 0.940 1.14(0.90- 1.44) 0.280 Heart Fatty Acid binding Protein 1.03(0.92-1.16) 0.575 0.89(0.68- 1.18) 0.424 1.01(0.87- 1.18) 0.866 0.99(0.915- 1.08) 0.926 Neurone Specific Eno-lase 1.03(0.94-1.14) 0.531 0.93(0.74- 1.18) 0.565 1.04(0.91- 1.19) 0.558 1.05(0.85- 1.28) 0.662 Neutrophil Gelatinase Ass. Lipocalin 1.01(0.91-1.12) 0.873 1.03(0.81- 1.31) 0.804 0.99(0.86- 1.14) 0.882 0.97(0.79- 1.20) 0.799 Anti- phoshorylcholine 0.92(0.80-1.06) 0.243 0.95(0.70- 1.29) 0.749 0.88(0.73- 1.01) 0.210 0.97(0.75- 1.26) 0.858 Table 1: Risk of recurrent stroke within 90 days (HR per decile increase in level) for 14 biomarker in patients presenting with TIA, minor ischaemic stroke (NIHSS≤3) and ma-jor ischaemic stroke. Hazard Ratio (95% Confidence Intervals) are adjusted for age and sex.
Karger_ESC London_2013
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