This article is more than 5 years old. Information may no longer be current.
Novel score predicts risk for early recurrent stroke
Results from a recent study have confirmed the validity of a score designed to predict patients with acute ischemic stroke who are at high risk for an early recurrent stroke.
Researchers validated the recurrence risk estimator score in 1,468 consecutive patients (median age, 69 years; 43.1% women) with acute ischemic stroke presenting at three centers, one each in the United States, Brazil and South Korea.
The recurrence risk estimator is a seven-point score composed of six predictors: one point for prior stroke or transient ischemic attack within the preceding month; subtype of cause of stroke, with one point if it is from large artery atherosclerosis or an uncommon cause; one point for multiple acute infarcts; one point if there are acute infarcts in both hemispheres or in both the anterior and posterior circulations; one point if there is a combination of acute and subacute infarcts; and one point if there is an isolated cortical location.
The primary outcome was recurrent ischemic stroke at 90 days, defined as a clinical incident that could clearly be attributed to a new area of brain infarction.
Higher score, greater recurrence risk
The score was calculated for each patient by an investigator masked to the patient’s recurrence status, and its predictive performance was assessed by calculating the area under the receiver operating characteristic curve, E. Murat Arsava, MD, from the department of neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey, and colleagues wrote.
Arsava and colleagues determined that the 90-day recurrence rate was 4.2% (95% CI, 3.2-5.2) and that the average recurrence risk estimator score was 2.2 (95% CI, 1.9-2.5) in patients who had a recurrence and 1 (95% CI, 1-1.1) in patients who did not.
Risk for recurrence rose with increasing recurrence risk estimator score (log-rank P < .001), they found.
According to the researchers, the score had good discrimination (area under the operator receiving curve, 0.76; 95% CI, 0.7-0.82).
The sensitivity for identifying patients as high risk, defined as having a more than 10% chance of stroke recurrence, was 41% and the specificity was 90%, whereas the sensitivity for identifying patients as low risk, defined as having a less than 1% chance of recurrent stroke, was 38% and the specificity was 93%, they wrote.
“Good discrimination suggests that the [recurrence risk estimator] may be useful in tailoring stroke management based on baseline stroke risk,” Arsava and colleagues wrote. “For instance, elective management of low-risk patients could be considered to ensure efficient use of health care resources. In contrast, high-risk patients could benefit from prompt evaluation and targeted preventive treatment in dedicated stroke centers.”
Graeme J. Hankey
Greatest value
In a related editorial, Graeme J. Hankey, MD, FRACP, FRCP, FAHA, from the University of Western Australia and Sir Charles Gairdner Hospital, Perth, and Chee-Keong Wee, MBBS, MRCP, from National Neuroscience Institute, Singapore, wrote that: “The greatest value of the [recurrence risk estimator] could perhaps be its ability to identify the one-third of patients with ischemic stroke who are at low risk of a recurrence. Only four (0.7%) of the 540 patients classified at low risk had a recurrent stroke, and four (6.8%) of the 59 patients who experienced a recurrent stroke had been classified (falsely) as low risk by the [recurrence risk estimator].” – by Erik Swain
Disclosure: The researchers and editorial authors report no relevant financial disclosures.