The Risk Factors Of Transient Ischemic Attack Patients And Its Risk Of Stroke

Cerebrovascular diseases are a kind of disease causing ischemic or hemorrhagic brain lesions by many factors. It is one of major diseases to harm the health of the aged. There are about 15 billion people die because of cerebrovascular diseases in the world every year, and it is also the highest cause of death in elderly of Chinese. TIAs are brief episodes of neurological dysfunction resulting from focal cerebral ischemia not associated with permanent cerebral infarction. In the past, TIAs were operationally defined as any focal cerebral ischemic event with symptoms lasting <24 hours. Recently, however, studies from many groups worldwide have demonstrated that this arbitrary time threshold was too broad because 30% to 50% of classically defined TIAs show brain injury on diffusion-weighted magnetic resonance(MR) imaging(MRI). the American Heart association(AHA) / American Stroke Association(ASA) posted on Stroke transient that ischemic attack(TIA) of the new definition, have advanced newer, neuroimaging-informed, operational definitions of TIA such as “a brief episode of neurological dysfunction caused by focal brain, spinal cord or retinal ischemia, with clinical symptoms typically lasting less than one hour, and without evidence of acute infarction. TIA is a chronic recurrentclinical syndrome, there are still some differences and disputes dispute about the etiology and pathogenesis of TIA. And the recognized reasons for TIA include atherosclerosis, micro embolism, heart disease, hemodynamic changes and changes of blood components. 10 to 15 percent patients have a stroke within 3 months, with half occurring within 48 hours. Acute treatments for TIA also have evolved, with new data supporting early rather than delayed carotid endarterectomy for TIA patients with carotid stenosis. TIA is a warning of stroke. With the ischemic time increased, the risk of stroke will increase, and the injury of focal brain, spinal cord or retinal ischemia will be irreversible. Therefore, early outcome evaluation of patients with TIA has important significance to prevent the occurrence of cerebral infarction.Patients who have diagnosed with transient ischemic attack(TIA) have a significant risk of stroke in the next week. Risk scores have been developed to assist in short-term risk stratification of patients with TIA. TIA may actually have alternative diagnoses such as seizure, migraine, or other nonvascular spells. The ABCD2 score uses clinical features, medical history, and blood pressure to generate a number that can be used to determine the patient’s short-term risk of stroke. ABCD2 Scoring Criteria: Age≥60 years(1 point); Blood pressure≥140/90 mm Hg(1 point); Clinical features Unilateral weakness(2 point); Speech impairment without weakness(1 point); Duration≥60 minutes(2 points); 10–59 minutes(1 point); Diabetes Presence of diabetes mellitus(1 point).Among patients diagnosed with TIA, higher ABCD2 score was associated with a greater likelihood that the diagnosis was confirmed on expert review. The predictive power of the ABCD2 model is therefore partially explained by identification of those patients likely to have experienced a true TIA, an important aspect of the score when used by nonneurologists. We chose to focus on ABCD2 due to its relative simplicity, extensive validation, and widespread clinical use. But ABCD2 score only include some clinical features, and its evaluation content does not include the pathophysiological factors of different etiology. Therefore, to rely solely on ABCD2 score to evaluate has certain limitation. C reactive protein(CRP) is released by infection or tissue damage. CRP plays an important role in the process of atherosclerotic plaque rupture. Recently, it has been reported that CRP was associated with TIA. And circulating CRP might be a potential biomarker for diagnosis and severity assessment of disease in acute cerebral infarction. We sought to evaluate the ability of the clinical efficacy of ABCD2 score combined with serum hs-CRP in the evaluation of risk of stroke to predict positive diagnostic test results in patients being acutely evaluated for TIA.Methods1. Epidemiological information included age, gender, education, body mass index, stroke history, heart disease, hypertension, diabetes, hypercholesterolemia, smoking and drinking status. Analyze the difference of age, gender, education, body mass index, stroke history, heart disease, hypertension, diabetes, hypercholesterolemia, smoking and drinking status between TIA and control group.2. 121 patients diagnosed with TIA were retrospectively analyzed with 35 case developed with stroke(stroke group) and 86 non-stroke(control group) within a month. The ABCD2 score and serum hs-CRP between the two groups were evaluated for evaluation of the risk of stroke.3. The patients diagnosed with TIA must be treated immediately, including the control of blood pressure, blood glucose and so on; and give aggregation and anticoagulant antiplatelet therapy, including Aspirin, Clopidogrel Bisulfate Tablets and low molecular heparin or intravenous drip anticoagulant therapy. But each patient due to the illness have some differences, medication is not the same.4. We Analyzed of acute cerebral infarction patients with ABCD2 score between the two groups of patients within one months and its prediction value.5. We Collected the TIA patients’ blood in the morning to detect serum hs-CRP concentration by ELISA method. Analysis of acute cerebral infarction patients and the occurrence of serum hs-CRP level between the two groups.6. Combination of ABCD2 score with the level of plasma hs-CRP in patients with acute cerebral infarction was used to predict the stroke within one month.Results1. Compared with the control group, TIA patients were older, more likely to be male, and displayed a higher frequency of family history of stroke, heart disease, hypertension, diabetes, current smoking, and drinking. There were no differences between TIA patients and control group in education levels, BMI and hyperlipidaemia.2. After adjusting for the other variates, age, gender, family history of stroke, heart disease, hypertension, and diabetes were still significantly associated with the risk of TIA. Education levels, BMI, hyperlipidemia and long-term smoking and drinking were not related with the risk of TIA when correcting for the other variates.3. The ABCD2 score in stroke group was much higher than that in control group with statistical significance( P<0.05).4. The serum hs-CRP level in stroke and control group were 23.71±4.56mg/L and 11.48±3.88mg/L respectively, which demonstrated that higher in stroke group(P<0.05); And significant correlation between ABCD2 score and serum hs-CRP was found in thepatients with TIA(rpearson=0.79,P<0.05).5. The sensitivity and specificity for ABCD2 score for predict stroke were 79.0% and 88.6% respectively, with an AUC of 0.92(95%CI:0.87-0.97).6.The sensitivity and specificity for serum hs-CRP for predict stroke were 80.7% and 60.8% respectively, with an AUC of 0.86(95%CI:0.79-0.93).7.The sensitivity and specificity for ABCD2 score combined with serum hs-CRP for predict stroke were 82.8% and 90.6% respectively, with an AUC of 0.931(95%CI:0.810-0.996)Conclusions1. Higher ABCD2 score and hs-CRP level were found in stroke group.2. ABCD2 score combined with serum hs-CRP can improve the sensitivity risk of development stroke in patients with TIA.