A score to predict one-year risk of recurrence after acute ischemic stroke
Date
2021Language
en
Sujet
Résumé
Background: An acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke. Methods: An integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens (n = 2495), Milan (n = 1279), and Helsinki (n = 714) by means of calibration and discrimination. Results: In the derivation cohort, the recurrence rate was 7% (n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9–4.1) in 932 (29%) patients with a score 0–1, 7.2% (6.1–8.3) in 2038 (63%) with a score 2–4, and 19.2% (14.6–23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively. Conclusion: We developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors. © 2020 World Stroke Organization.
Collections
Related items
Showing items related by title, author, creator and subject.
-
Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society
Sagris D., Ntaios G., Georgiopoulos G., Kakaletsis N., Elisaf M., Katsiki N., Korompoki E., Kypreos K.E., Boutari C., Bilianou H., Makaritsis K., Nomikos T., Papavasileiou V., Pitsavos C., Plomaritoglou A., Spengos K., Tziomalos K., Tselepis A., Vemmos K., Liberopoulos E., Milionis H. (2021)This document presents the consensus recommendations of the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society for lipid modification in patients with ischemic stroke or transient ischemic attack. This ... -
Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study
Paciaroni M., Caso V., Agnelli G., Mosconi M.G., Giustozzi M., Seiffge D.J., Engelter S.T., Lyrer P., Polymeris A.A., Kriemler L., Zietz A., Putaala J., Strbian D., Tomppo L., Michel P., Strambo D., Salerno A., Remillard S., Buehrer M., Bavaud O., Vanacker P., Zuurbier S., Yperzeele L., Loos C.M.J., Cappellari M., Emiliani A., Zedde M., Abdul-Rahim A., Dawson J., Cronshaw R., Schirinzi E., Del Sette M., Stretz C., Kala N., Reznik M., Schomer A., Grory B.M., Jayaraman M., Mctaggart R., Yaghi S., Furie K.L., Masotti L., Grifoni E., Toni D., Risitano A., Falcou A., Petraglia L., Lotti E.M., Padroni M., Pavolucci L., Lochner P., Silvestrelli G., Ciccone A., Alberti A., Venti M., Traballi L., Urbini C., Kargiotis O., Rocco A., Diomedi M., Marcheselli S., Caliandro P., Zauli A., Reale G., Antonenko K., Rota E., Tassinari T., Saia V., Palmerini F., Aridon P., Arnao V., Monaco S., Cottone S., Baldi A., D'Amore C., Ageno W., Pegoraro S., Ntaios G., Sagris D., Giannopoulos S., Kosmidou M., Ntais E., Romoli M., Pantoni L., Rosa S., Bertora P., Chiti A., Canavero I., Saggese C.E., Plocco M., Giorli E., Palaiodimou L., Bakola E., Tsivgoulis G., Bandini F., Gasparro A., Terruso V., Mannino M., Pezzini A., Ornello R., Sacco S., Popovic N., Scoditti U., Genovese A., Denti L., Flomin Y., Mancuso M., Ferrari E., Caselli M.C., Ulivi L., Giannini N., De Marchis G.M. (2022)BACKGROUND: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings ... -
Rationale and design of the AXIOMATIC-SSP phase II trial: Antithrombotic treatment with factor XIa inhibition to Optimize Management of Acute Thromboembolic events for Secondary Stroke Prevention
Sharma M., Molina C.A., Toyoda K., Bereczki D., Kasner S.E., Lutsep H.L., Tsivgoulis G., Ntaios G., Czlonkowska A., Shuaib A., Amarenco P., Endres M., Diener H.C., Gailani D., Kahl A., Donovan M., Perera V., Li D., Hankey G.J. (2022)Background: Individuals with ischemic stroke or transient ischemic attack (TIA) have a high early risk of ischemic stroke despite dual antiplatelet therapy. The risk of ischemic stroke, and associated disability, represents ...