Radiological predictive model of 2-year recurrence after ischemic stroke; The Boramae Stroke Risk Score (BSRS)

Introduction: Atrial fibrillation (AF) is a major risk factor for acute ischemic stroke (AIS). Anticoagulation therapy (OAC) effectively prevents AIS, but increases bleeding risk. There is a need for better AIS risk prediction to optimize the anticoagulation decision in AF. The ATRIA stroke risk score (ATRIA) (table) was superior to CHADS2 and CHA2DS2-VASc in two large California community AF cohorts. We now report the performance of the 3 scores in a very large Swedish AF cohort. Methods: The cohort consisted of all Swedish patients hospitalized with a diagnosis of AF from July 1, 2005 to December 31, 2008. Predictor variables and the outcome, AIS, were obtained from inpatient ICD-10 codes. Warfarin use was determined from National Pharmacy Database. Risk scores were assessed via c-index (C) and net reclassification index (NRI). Results: The cohort included 158,370 AF patients off warfarin who contributed 340,332 person-years of follow-up, and 11,823 incident AIS, for an overall AIS rate of 3.47%/yr, higher than the 2%/yr seen in the California cohorts. Using the entire point score, ATRIA had a good C of 0.712 (0.708-0.716), significantly better than CHADS2, 0.694 (0.689-0.698), or CHA2DS2-VASc, 0.697 (0.693-0.702). Using published cut-points for Low/Moderate/High AIS risk, C deteriorated for all scores but ATRIA and CHADS2 were superior to CHA2DS2-VASc. NRI favored ATRIA; 0.16 (0.15-0.18) versus CHADS2; 0.22 (0.21-0.24) versus CHA2DS2-VASc. However, NRI decreased to near-zero when cut-points were altered to better fit the cohort’s stroke rates. Conclusion: Findings in this large Swedish AF cohort validate those in the California AF cohorts, with the ATRIA score predicting stroke risk better than CHADS2 or CHA2DS2-VASc. However, relative performance of the categorical scores varied by population stroke risk. Knowledge about this population risk may be needed to optimize cut-points on the multipoint scores to achieve better net clinical benefit from OAC.

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Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

Scientific Reports ◽

10.1038/s41598-020-73836-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Joon-Tae Kim ◽

Beom Joon Kim ◽

Jong-Moo Park ◽

Soo Joo Lee ◽

Jae-Kwan Cha ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk ◽

Recurrent Stroke ◽

Vascular Events ◽

Factors Associated ◽

Increased Risk ◽

Potential Factors ◽

Predictive Risk ◽

Multicenter Registry

Abstract Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

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A Validation of the Essen Stroke Risk Score in Outpatients with Ischemic Stroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2016.02.001 ◽

2016 ◽

Vol 25 (9) ◽

pp. 2189-2195 ◽

Cited By ~ 3

Author(s):

Pan Chen ◽

Yi Liu ◽

Yilong Wang ◽

Anxin Wang ◽

Huaguang Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk

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A modified Essen Stroke Risk Score for predicting recurrent ischemic stroke at one year

Neurological Research ◽

10.1080/01616412.2018.1428389 ◽

2018 ◽

Vol 40 (3) ◽

pp. 204-210 ◽

Cited By ~ 4

Author(s):

Xia Ling ◽

Shuang-Mei Yan ◽

Bo Shen ◽

Xu Yang

Keyword(s):

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk ◽

One Year

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Risk Factors Associated With Outcomes of Non-cardioembolic Ischemic Stroke In Patients Stratified By Essen Stroke Risk Score

10.21203/rs.2.22244/v1 ◽

2020 ◽

Author(s):

Yanting Ping Ping ◽

Qianqian Yang Yang ◽

Yuwen Huang Huang ◽

Huimin Xu Xu ◽

Haibin Dai

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Risk Score ◽

Protective Factor ◽

Stroke Risk ◽

Recurrent Stroke ◽

Univariate Analysis ◽

Tertiary Care ◽

Vascular Events ◽

Stroke Outcomes

Abstract Background: Identifying risk factors of cardiovascular events is crucial for stroke prevention and they can be used as predictive factors of stroke outcomes.In this study, it is to evaluate the risk factors that predict outcomes of acute non-cardioembolic ischemic stroke in patients stratified by Essen Stroke Risk Score (ESRS). Methods: A retrospective study was carried out in acute non-cardioembolic ischemic stroke patients in a Chinese tertiary-care teaching hospital. ESRS stratification and factors that might influence the outcomes of stroke, as indicated by fatal or non-fatal combined vascular events of recurrent stroke, myocardial infarction, or primary intracranial hemorrhage, were documented. Univariate analysis and multivariable regression analysis was used to identify independent predictors of stroke outcomes. Results: A total of 878 patients with acute non-cardioembolic ischemic stroke who completed a mean follow-up of 5.2 years were enrolled, and 163 patients experienced at least one component of the combined vascular event. In patients with an ESRS ≤ 3, age ≥ 65 years (OR , 2.935; 95% CI 1.625-5.301, P < 0.001) and clopidogrel treatment (OR , 1.685 ; 95% CI , 1.026-2.768; P = 0.041) were significantly associated with stroke outcomes. In patients with an ESRS > 3, age ≥ 65 years (OR , 2.107, 95% CI , 1.208-3.673 ; P = 0.008) and history of diabetes (OR , 1.465 ; 95% CI , 1.041–2.062 ; P = 0.027) were risk factors for stroke outcomes , whereas clopidogrel treatment (OR , 0.542; 95% CI , 0.356–0.824; P = 0.003) was a protective factor for stroke outcomes. Conclusions: According to this study, clopidogrel treatment, blood pressure control, and glycemic control are protective factors for stroke outcomes in high-risk patients (ESRS>3).

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Risk Score for Predicting Recurrence in Patients with Ischemic Stroke: The Fukuoka Stroke Risk Score for Japanese

Cerebrovascular Diseases ◽

10.1159/000343503 ◽

2012 ◽

Vol 34 (5-6) ◽

pp. 351-357 ◽

Cited By ~ 22

Author(s):

Masahiro Kamouchi ◽

Naoko Kumagai ◽

Yasushi Okada ◽

Hideki Origasa ◽

Takenori Yamaguchi ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Score ◽

Stroke Risk

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White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction

Cerebrovascular Diseases ◽

10.1159/000450962 ◽

2016 ◽

Vol 43 (1-2) ◽

pp. 17-24 ◽

Cited By ~ 3

Author(s):

Søren Due Andersen ◽

Torben Bjerregaard Larsen ◽

Anders Gorst-Rasmussen ◽

Yousef Yavarian ◽

Gregory Y.H. Lip ◽

...

Keyword(s):

Ischemic Stroke ◽

White Matter ◽

Risk Score ◽

White Matter Hyperintensities ◽

Stroke Risk ◽

Risk Scores ◽

Stroke Recurrence ◽

Cerebral White Matter ◽

Clinical Scores ◽

Recurrence Prediction

Background: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous. In a non-AF stroke cohort, we investigated the association between cerebral white matter hyperintensities and the risk of recurrent ischemic stroke, and we evaluated the predictive performance of the CHA2DS2VASc score and the Essen Stroke Risk Score (clinical scores) when augmented with information on white matter hyperintensities. Methods: In a registry-based, observational cohort study, we included 832 patients (mean age 59.6 (SD 13.9); 42.0% females) with incident ischemic stroke and no AF. We assessed the severity of white matter hyperintensities using MRI. Hazard ratios stratified by the white matter hyperintensities score and adjusted for the components of the CHA2DS2VASc score were calculated based on the Cox proportional hazards analysis. Recalibrated clinical scores were calculated by adding one point to the score for the presence of moderate to severe white matter hyperintensities. The discriminatory performance of the scores was assessed with the C-statistic. Results: White matter hyperintensities were significantly associated with the risk of recurrent ischemic stroke after adjusting for clinical risk factors. The hazard ratios ranged from 1.65 (95% CI 0.70-3.86) for mild changes to 5.28 (95% CI 1.98-14.07) for the most severe changes. C-statistics for the prediction of recurrent ischemic stroke were 0.59 (95% CI 0.51-0.65) for the CHA2DS2VASc score and 0.60 (95% CI 0.53-0.68) for the Essen Stroke Risk Score. The recalibrated clinical scores showed improved C-statistics: the recalibrated CHA2DS2VASc score 0.62 (95% CI 0.54-0.70; p = 0.024) and the recalibrated Essen Stroke Risk Score 0.63 (95% CI 0.56-0.71; p = 0.031). C-statistics of the white matter hyperintensities score were 0.62 (95% CI 0.52-0.68) to 0.65 (95% CI 0.58-0.73). Conclusions: An increasing burden of white matter hyperintensities was independently associated with recurrent ischemic stroke in a cohort of non-AF ischemic stroke patients. Recalibration of the CHA2DS2VASc score and the Essen Stroke Risk Score with one point for the presence of moderate to severe white matter hyperintensities led to improved discriminatory performance in ischemic stroke recurrence prediction. Risk scores based on white matter hyperintensities alone were at least as accurate as the established clinical risk scores in the prediction of ischemic stroke recurrence.

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