22. European Stroke Conference 87 Stroke prognosis Improved risk stratification after TIA; addition of brain, cardiac, carotid imaging data to the ABCD2 score O. Y. Fartushna1, J. Dawson2, L. I. Sokolova3 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM1, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM2, Bogomolets National medical University, Kiev, UKRAINA3 Background: The ABCD2 score can identify those at particularly high risk for stroke after TIA yet does not incorporate other routinely gathered data known to link with increased stroke risk. We de-veloped and validated a predictive model based on the ABCD2 score with the addition of brain, car-diac and carotid imaging data. Methods: We included 178 consenting patients with a diagnosis of TIA who presented to the Alex-ander University Central Hospital, Kiev, Ukraine. All gave written informed consent to participate. All patients had detailed clinical assessment, carotid Doppler ultrasound imaging, diffusion weight-ed MRI (DWI), transthoracic echocardiography and cardiology review. Participants were spilt ran-domly into a development set (n=110) and independent test set (n=68). Development of stroke after TIA was the primary endpoint. Results: In the development sample, stroke developed in 28 (25.5%) patients. The ABCD2 score was predictive of recurrent stroke (Area under ROC 0.72 (95% CI - 0.62 to 0.83). A regression mod-el based on ABCD2 score only gave sensitivity of 32.1% and specificity 87.8% for the prediction of recurrent stroke. Increased interventricular septal and carotid intima media thickness, presence of moderate carotid artery stenosis and a DWI lesion were predictive of recurrent stroke. A regression model based on these variables, in addition to ABCD2 score gave sensitivity of 55.6% and specific-ity of 92.6% for the prediction of recurrent stroke. Results were similar in the independent test set (table). Conclusions: Incorporation of routinely gathered imaging variables to risk stratification using the ABCD2 score increases sensitivity for the prediction of recurrent stroke. Table. Prediction of recurrent stroke by the ABCD2 score and a New predictive model in the develop-ment and independent test sets Prediction of recurrent stroke 326 © 2013 S. Karger AG, Basel Scientific Programme after TIA Groups of the patients Development set, n=110 Independent test set, n=68 Stroke frequency, n (%) 28 (25.5%) 17(25.0%) ABCD2 score, Area under ROC (95% CI) 0.72 (0.62-0.83) 0.75 (0.63-0.87) ABCD2 score sensitivity, % 32.1 35.3 ABCD2 score specificity, % 87.8 86.3 New predictive model sensitiv-ity, % 55.6 41.2 New predictive model specific-ity, % 92.6 91.4 88 Stroke prognosis Preceding and post-stroke infections in young adults with first-ever ischemic stroke are asso-ciated with unfavorable short-term and long-term outcome. T.J. Heikinheimo_Connell1, J. Broman2, E. Haapaniemi3, M. Kaste4, T. Tatlisumak5, J. Putaala6 Department of neurology, Helsinki University Central Hospital, Helsinki, FINLAND1, De-partment of neurology, Helsinki University Central Hospital, Helsinki, FINLAND2, Department of neurology, Helsinki University Central Hospital, Helsinki, FINLAND3, Department of neurology, Helsinki University Central Hospital, Helsinki, FINLAND4, Department of neurology, Helsinki Uni-versity Central Hospital, Helsinki, FINLAND5, Department of neurology, Helsinki University Cen-tral Hospital, Helsinki, FINLAND6 Background: There are mixed results how preceding infection (PI) affects the prognosis of ischemic stroke, but it is well known that post-stroke infections (PSI) worsen the outcome in acute ischemic stroke. Our objectives were to characterize PI and PSI in young adults with first-ever stroke and to study, whether they are associated with unfavorable 3-month outcome. We studied also whether such infections are associated with on long-term outcome, recurrent vascular events and death. Methods: From our database of 1008 consecutive patients aged 15 to 49 we included in the present study those who had brain imaging done within the first two days from stroke onset. Study out-comes were 3-month and long-term (follow-up 7.8±4.0 years) disability, vascular events and death. Logistic regression and Cox proportional models were used to find out associations between infec-tions and clini-cal outcomes. Results: 681 patients (62.3% males) fulfilled the inclusion criteria. Of them 73 had PI, most com-monly upper respiratory tract infection, and103 had PSI, most commonly pneumonia. After ad-justing with gender, age and risk factors both PI and PSI were associated with unfavorable 3-mont outcome in young patients with acute ischemic stroke. After exclusion of those dying within 30- days from stroke, PSI was associated with higher long-term mortality Conclusion: In young stroke patients pre and post-stroke infections were independently associated with unfavorable 3-month outcome. Post-stroke infections were also associated with long-term risk of death.
Karger_ESC London_2013
To see the actual publication please follow the link above