ABSTRACT NUMBER: ESOC2026A1787 INTEGRATION OF SYSTEMIC INFLAMMATORY MARKERS INTO POST-TIA RISK STRATIFICATION: DEVELOPMENT AND VALIDATION OF THE ABCD2-I MODEL

Abstract Background and aims Transient ischemic attack (TIA) confers a high early risk of subsequent ischemic stroke. Systemic inflammatory activation may contribute to this risk, but the prognostic value of inflammatory indices in TIAs remains unclear. We assessed their association with clinical outcomes and their role in refining ABCD2-based risk stratification. Methods We conducted a multicenter retrospective–prospective observational study including consecutive TIA patients admitted between January 2023 and August 2025. Systemic inflammatory indices (NLR, PLR, LMR, SII, SIRI) were derived from admission blood samples. Primary outcome was 90-day major adverse cardiovascular events (MACE); secondary outcomes included occurrence of stroke or TIA, ischemic stroke, and all-cause mortality up to 12 months. ROC analysis was used to develop a predictive model integrating inflammatory indices with the ABCD2 score (ABCD2-I). Results Among 291 patients included, 10% suffered from 90-day MACE. At multivariable analysis, increasing admission NLR independently predicted 90-day MACE (OR 1.70, 95%CI 1.12–2.58; p = 0.013). NLR was also associated with ischemic stroke or TIA (OR 1.48, 95%CI 1.02–2.13; p = 0.037), while ischemic stroke was independently associated with both NLR (OR 2.74, 95%CI 1.39–5.40; p = 0.003) and PLR (OR 1.01, 95%CI 1.00–1.02; p = 0.029). No inflammatory index predicted mortality. Integration of NLR into the ABCD2 score improved discrimination (AUC 0.605 vs 0.668), with an optimal cut-off of 4. Conclusions In TIA patients, systemic inflammatory burden independently predicts ischemic recurrence, and its integration into ABCD2 improves identification of high-risk patients beyond clinical models. Conflict of interest Marco Andrighetti: nothing to disclose.