Department of Clinical Neurology, University of Oxford, on behalf of the Oxford Vascular Study, Stroke Prevention Research Unit, Oxford University Department of Clinical Neurology, John Radcliffe Hospital, Oxford, UK.
Stroke. 2011 Mar;42(3):632-7. doi: 10.1161/STROKEAHA.110.593301. Epub 2011 Jan 27.
The ABCD(2) score predicts the early risk of stroke after transient ischemic attack. The early risk of recurrence after minor stroke is as high but the only validated prognostic scores for use in minor stroke predict long-term risk of recurrence: the Essen Stroke Risk Score and the Stroke Prognosis Instrument II.
We determined the prognostic value of the ABCD(2) score, Essen Stroke Risk Score, and Stroke Prognosis Instrument II in a prospective population-based study in Oxfordshire, UK, of all incident and recurrent stroke (Oxford Vascular Study). Minor stroke was defined as an National Institutes of Health Stroke Scale score ≤5 at the time of first assessment. The 90-day risks of recurrent stroke were determined in relation to each score. Areas under the receiver operator curves indicated predictive value.
Of 1247 first events in the study period, 488 were transient ischemic attacks, 520 were minor strokes, and 239 were major strokes. The ABCD(2) score was modestly predictive (area under the receiver operator curve, 0.64; 0.53 to 0.74; P=0.03) of recurrence at 7 days after minor stroke and at 90 days (0.62; 0.54 to 0.70; P=0.004). Neither Essen Stroke Risk Score (0.50; 0.42 to 0.59; P=0.95) nor Stroke Prognosis Instrument II (0.48; 0.39 to 0.60; P=0.92) were predictive of 7-day or 90-day risk of recurrent stroke. Of the traditional vascular risk factors, etiologic classification (Trial of ORG 10172 in Acute Stroke Treatment) and variables in the ABCD(2) score, only blood pressure >140/90 mm Hg (hazard ratio, 2.75; 1.18 to 6.38; P=0.02) and large artery disease (hazard ratio, 2.21; 1.00 to 4.88; P=0.05) were predictive of 90-day risk.
The predictive power of the ABCD(2) score is modest in patients with minor stroke, and neither the Essen Stroke Risk Score nor the Stroke Prognosis Instrument II predicts early recurrence. More reliable early risk prediction after minor stroke is required.
ABCD(2)评分可预测短暂性脑缺血发作后的早期卒中风险。小型卒中后复发的早期风险同样很高，但目前唯一经过验证的可用于小型卒中的预后评分可预测长期复发风险：Essen 卒中风险评分和卒中预后工具 II。
我们在英国牛津郡的一项前瞻性基于人群的牛津血管研究中，对所有首发和复发性卒中（牛津卒中研究）患者，评估了 ABCD(2)评分、Essen 卒中风险评分和卒中预后工具 II 的预后价值。首次评估时 NIHSS 评分为 5 分及以下定义为小卒中。根据各评分确定 90 天内的卒中复发风险。受试者工作特征曲线下面积表明预测价值。
在研究期间，1247 例首发事件中，488 例为短暂性脑缺血发作，520 例为小卒中，239 例为大卒 中。ABCD(2)评分对小卒中后 7 天和 90 天的复发有一定的预测价值（受试者工作特征曲线下面积，0.64；0.53 至 0.74；P=0.03）。Essen 卒中风险评分（0.50；0.42 至 0.59；P=0.95）和卒中预后工具 II（0.48；0.39 至 0.60；P=0.92）均不能预测 7 天或 90 天的卒中复发风险。在传统血管危险因素中，病因分类（急性卒中治疗 ORG 10172 试验）和 ABCD(2)评分中的变量中，仅血压>140/90mmHg（危险比，2.75；1.18 至 6.38；P=0.02）和大动脉疾病（危险比，2.21；1.00 至 4.88；P=0.05）与 90 天的风险相关。
ABCD(2)评分在小卒中患者中的预测能力有限，Essen 卒中风险评分和卒中预后工具 II 均不能预测早期复发。需要更可靠的小型卒中后早期风险预测。
