Validation of the Canadian TIA Score to Predict Subsequent Stroke Risk in Chinese TIA Patients

Abstract

<b><i>Background and Objectives:</i></b> The Canadian TIA Score has been verified as a good predictive tool for subsequent stroke risk in Caucasian patients; however, it had insufficient external verification of other races. We aimed to validate the Canadian TIA Score in Chinese patients and compared it with ABCD² for subsequent stroke risk after transient ischemic attack (TIA). <b><i>Methods:</i></b> The Third China National Stroke Registry (CNSR-III) was a nationwide, multicenter prospective registry recruiting consecutive patients with acute ischemic stroke or TIA within 7 days of the onset from August 2015 to March 2018. The Canadian TIA Score was verified in patients diagnosed with TIA from the CNSR-III (<i>N</i> = 1,184). The outcomes were subsequent stroke at 7 days, 14 days/discharge, 3 months, and 1 year. Outcomes were recorded by face-to-face assessment or telephone interview. The prognostic performance of the scoring system was assessed by the area under the receiver operator characteristic curve (AUC). <b><i>Results:</i></b> Of 1,184 TIA patients (mean [IQR] age, 61.00 [53.00–69.00] years; 413 women [34.88%]), there were 40 patients (3.38%) having subsequent stroke within 7 days, 45 (3·80%) within 14 days/hospitalization, 66 (5·57%) within 3 months, and 100 (8·45%) within 1 year. The Canadian TIA Score (AUC 0 63–0·68) seemed to be a better prognostic score of stroke risk than the ABCD² score (AUC 0·61–0·62), although no significant differences were noted. In the subgroup of atypical TIA, the Canadian TIA Score showed significantly stronger predictivity than the ABCD² score within 7 days (0.80 [0.62–0.98] vs. 0.52 [0.30–0.73]; difference in AUC, 0.28 [0.03–0.53]; <i>p</i>, 0.026), and marginal significantly stronger predictivity within 1 year (0.71 [0.61–0.80] vs. 0.58 [0.48–0.68]; difference in AUC, 0.12 [−0.01 to 0.25]; <i>p</i>, 0.06). <b><i>Conclusion:</i></b> The Canadian TIA Score might be a better prognostic score than the ABCD² score for post-TIA stroke risk, especially in patients with atypical TIA.