Posttreatment Variables Improve Outcome Prediction after Intra-Arterial Therapy for Acute Ischemic Stroke
Identifieur interne : 002600 ( Ncbi/Merge ); précédent : 002599; suivant : 002601Posttreatment Variables Improve Outcome Prediction after Intra-Arterial Therapy for Acute Ischemic Stroke
Auteurs : Shyam Prabhakaran ; Tudor G. Jovin ; Ashis H. Tayal ; Muhammad S. Hussain [États-Unis] ; Thanh N. Nguyen ; Kevin N. Sheth ; John B. Terry [États-Unis] ; Raul G. Nogueira ; Anat Horev ; Dheeraj Gandhi ; Dolora Wisco [États-Unis] ; Brenda A. Glenn ; Bryan Ludwig [États-Unis] ; Paul F. Clemmons ; Carolyn A. Cronin ; Melissa Tian ; David Liebeskind ; Osama O. Zaidat ; Alicia C. Castonguay ; Coleman Martin ; Nils Mueller-Kronast ; Joey D. English ; Italo Linfante ; Timothy W. Malisch [États-Unis] ; Rishi GuptaSource :
- Cerebrovascular diseases (Basel, Switzerland) [ 1015-9770 ] ; 2014.
Abstract
There are multiple clinical and radiographic factors that influence outcomes after endovascular reperfusion therapy (ERT) in acute ischemic stroke (AIS). We sought to derive and validate an outcome prediction score for AIS patients undergoing ERT based on readily available pretreatment and posttreatment factors.
The derivation cohort included 511 patients with anterior circulation AIS treated with ERT at 10 centers between September 2009 and July 2011. The prospective validation cohort included 223 patients with anterior circulation AIS treated in the North American Solitaire Acute Stroke registry. Multivariable logistic regression identified predictors of good outcome (modified Rankin score ≤2 at 3 months) in the derivation cohort; model β coefficients were used to assign points and calculate a risk score. Discrimination was tested using C statistics with 95% confidence intervals (CIs) in the derivation and validation cohorts. Calibration was assessed using the Hosmer-Lemeshow test and plots of observed to expected outcomes. We assessed the net reclassification improvement for the derived score compared to the Totaled Health Risks in Vascular Events (THRIVE) score. Subgroup analysis in patients with pretreatment Alberta Stroke Program Early CT Score (ASPECTS) and posttreatment final infarct volume measurements was also performed to identify whether these radiographic predictors improved the model compared to simpler models.
Good outcome was noted in 186 (36.4%) and 100 patients (44.8%) in the derivation and validation cohorts, respectively. Combining readily available pretreatment and posttreatment variables, we created a score (acronym: SNARL) based on the following parameters: symptomatic hemorrhage [2 points: none, hemorrhagic infarction (HI)1–2 or parenchymal hematoma (PH) type 1; 0 points: PH2], baseline National Institutes of Health Stroke Scale score (3 points: 0–10; 1 point: 11–20; 0 points: >20), age (2 points: <60 years; 1 point: 60–79 years; 0 points: >79 years), reperfusion (3 points: Thrombolysis In Cerebral Ischemia score 2b or 3) and location of clot (1 point: M2; 0 points: M1 or internal carotid artery). The SNARL score demonstrated good discrimination in the derivation (C statistic 0.79, 95% CI 0.75–0.83) and validation cohorts (C statistic 0.74, 95% CI 0.68–0.81) and was superior to the THRIVE score (derivation cohort: C statistic 0.65, 95% CI 0.60–0.70; validation cohort: C-statistic 0.59, 95% CI 0.52–0.67; p < 0.01 in both cohorts) but was inferior to a score that included age, ASPECTS, reperfusion status and final infarct volume (C statistic 0.86, 95% CI 0.82–0.91; p = 0.04). Compared with the THRIVE score, the SNARL score resulted in a net reclassification improvement of 34.8%.
Among AIS patients treated with ERT, pretreatment scores such as the THRIVE score provide only fair prognostic information. Inclusion of posttreatment variables such as reperfusion and symptomatic hemorrhage greatly influences outcome and results in improved outcome prediction.
Url:
DOI: 10.1159/000362591
PubMed: 24942008
PubMed Central: 4157916
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<author><name sortKey="Prabhakaran, Shyam" sort="Prabhakaran, Shyam" uniqKey="Prabhakaran S" first="Shyam" last="Prabhakaran">Shyam Prabhakaran</name>
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<author><name sortKey="Tayal, Ashis H" sort="Tayal, Ashis H" uniqKey="Tayal A" first="Ashis H." last="Tayal">Ashis H. Tayal</name>
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<author><name sortKey="Hussain, Muhammad S" sort="Hussain, Muhammad S" uniqKey="Hussain M" first="Muhammad S." last="Hussain">Muhammad S. Hussain</name>
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<author><name sortKey="Nguyen, Thanh N" sort="Nguyen, Thanh N" uniqKey="Nguyen T" first="Thanh N." last="Nguyen">Thanh N. Nguyen</name>
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<author><name sortKey="Sheth, Kevin N" sort="Sheth, Kevin N" uniqKey="Sheth K" first="Kevin N." last="Sheth">Kevin N. Sheth</name>
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<author><name sortKey="Horev, Anat" sort="Horev, Anat" uniqKey="Horev A" first="Anat" last="Horev">Anat Horev</name>
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<author><name sortKey="Gandhi, Dheeraj" sort="Gandhi, Dheeraj" uniqKey="Gandhi D" first="Dheeraj" last="Gandhi">Dheeraj Gandhi</name>
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<author><name sortKey="Wisco, Dolora" sort="Wisco, Dolora" uniqKey="Wisco D" first="Dolora" last="Wisco">Dolora Wisco</name>
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<author><name sortKey="Glenn, Brenda A" sort="Glenn, Brenda A" uniqKey="Glenn B" first="Brenda A." last="Glenn">Brenda A. Glenn</name>
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<wicri:noCountry code="subfield">Ga</wicri:noCountry>
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<author><name sortKey="Cronin, Carolyn A" sort="Cronin, Carolyn A" uniqKey="Cronin C" first="Carolyn A." last="Cronin">Carolyn A. Cronin</name>
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<author><name sortKey="Tian, Melissa" sort="Tian, Melissa" uniqKey="Tian M" first="Melissa" last="Tian">Melissa Tian</name>
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</affiliation>
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<author><name sortKey="Liebeskind, David" sort="Liebeskind, David" uniqKey="Liebeskind D" first="David" last="Liebeskind">David Liebeskind</name>
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</affiliation>
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<author><name sortKey="Zaidat, Osama O" sort="Zaidat, Osama O" uniqKey="Zaidat O" first="Osama O." last="Zaidat">Osama O. Zaidat</name>
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<wicri:noCountry code="subfield">Wis</wicri:noCountry>
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<author><name sortKey="Martin, Coleman" sort="Martin, Coleman" uniqKey="Martin C" first="Coleman" last="Martin">Coleman Martin</name>
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<author><name sortKey="Mueller Kronast, Nils" sort="Mueller Kronast, Nils" uniqKey="Mueller Kronast N" first="Nils" last="Mueller-Kronast">Nils Mueller-Kronast</name>
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<wicri:noCountry code="subfield">Fla</wicri:noCountry>
</affiliation>
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<author><name sortKey="English, Joey D" sort="English, Joey D" uniqKey="English J" first="Joey D." last="English">Joey D. English</name>
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<author><name sortKey="Linfante, Italo" sort="Linfante, Italo" uniqKey="Linfante I" first="Italo" last="Linfante">Italo Linfante</name>
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<wicri:noCountry code="subfield">Fla</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Malisch, Timothy W" sort="Malisch, Timothy W" uniqKey="Malisch T" first="Timothy W." last="Malisch">Timothy W. Malisch</name>
<affiliation wicri:level="1"><nlm:aff id="A17">Alexian Brothers Medical Center, Elk Grove Village, Ill., USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Alexian Brothers Medical Center, Elk Grove Village, Ill.</wicri:regionArea>
<wicri:noRegion>Ill.</wicri:noRegion>
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<author><name sortKey="Gupta, Rishi" sort="Gupta, Rishi" uniqKey="Gupta R" first="Rishi" last="Gupta">Rishi Gupta</name>
<affiliation><nlm:aff id="A8">Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga</nlm:aff>
<wicri:noCountry code="subfield">Ga</wicri:noCountry>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Posttreatment Variables Improve Outcome Prediction after Intra-Arterial Therapy for Acute Ischemic Stroke</title>
<author><name sortKey="Prabhakaran, Shyam" sort="Prabhakaran, Shyam" uniqKey="Prabhakaran S" first="Shyam" last="Prabhakaran">Shyam Prabhakaran</name>
<affiliation><nlm:aff id="A1">Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill</nlm:aff>
<wicri:noCountry code="subfield">Ill</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Jovin, Tudor G" sort="Jovin, Tudor G" uniqKey="Jovin T" first="Tudor G." last="Jovin">Tudor G. Jovin</name>
<affiliation><nlm:aff id="A2">Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center</nlm:aff>
<wicri:noCountry code="subfield">University of Pittsburgh Medical Center</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Tayal, Ashis H" sort="Tayal, Ashis H" uniqKey="Tayal A" first="Ashis H." last="Tayal">Ashis H. Tayal</name>
<affiliation><nlm:aff id="A3">Department of Neurology, Allegheny General Hospital, Pittsburgh, Pa</nlm:aff>
<wicri:noCountry code="subfield">Pa</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Hussain, Muhammad S" sort="Hussain, Muhammad S" uniqKey="Hussain M" first="Muhammad S." last="Hussain">Muhammad S. Hussain</name>
<affiliation wicri:level="2"><nlm:aff id="A4">Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, Ohio</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Ohio</region>
</placeName>
<wicri:cityArea>Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Nguyen, Thanh N" sort="Nguyen, Thanh N" uniqKey="Nguyen T" first="Thanh N." last="Nguyen">Thanh N. Nguyen</name>
<affiliation><nlm:aff id="A5">Departments of Neurology and Radiology, Boston University School of Medicine, Boston, Mass</nlm:aff>
<wicri:noCountry code="subfield">Mass</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Sheth, Kevin N" sort="Sheth, Kevin N" uniqKey="Sheth K" first="Kevin N." last="Sheth">Kevin N. Sheth</name>
<affiliation><nlm:aff id="A6">Department of Neurology, Yale University School of Medicine, New Haven, Conn</nlm:aff>
<wicri:noCountry code="subfield">Conn</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Terry, John B" sort="Terry, John B" uniqKey="Terry J" first="John B." last="Terry">John B. Terry</name>
<affiliation wicri:level="2"><nlm:aff id="A7">Department of Internal Medicine (Neurology), Miami Valley Hospital, Wright State University, Boonshoft School of Medicine, Dayton, Ohio</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Ohio</region>
</placeName>
<wicri:cityArea>Department of Internal Medicine (Neurology), Miami Valley Hospital, Wright State University, Boonshoft School of Medicine, Dayton</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Nogueira, Raul G" sort="Nogueira, Raul G" uniqKey="Nogueira R" first="Raul G." last="Nogueira">Raul G. Nogueira</name>
<affiliation><nlm:aff id="A8">Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga</nlm:aff>
<wicri:noCountry code="subfield">Ga</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Horev, Anat" sort="Horev, Anat" uniqKey="Horev A" first="Anat" last="Horev">Anat Horev</name>
<affiliation><nlm:aff id="A2">Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center</nlm:aff>
<wicri:noCountry code="subfield">University of Pittsburgh Medical Center</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Gandhi, Dheeraj" sort="Gandhi, Dheeraj" uniqKey="Gandhi D" first="Dheeraj" last="Gandhi">Dheeraj Gandhi</name>
<affiliation><nlm:aff>NONE</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Wisco, Dolora" sort="Wisco, Dolora" uniqKey="Wisco D" first="Dolora" last="Wisco">Dolora Wisco</name>
<affiliation wicri:level="2"><nlm:aff id="A4">Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, Ohio</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Ohio</region>
</placeName>
<wicri:cityArea>Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Glenn, Brenda A" sort="Glenn, Brenda A" uniqKey="Glenn B" first="Brenda A." last="Glenn">Brenda A. Glenn</name>
<affiliation><nlm:aff id="A8">Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga</nlm:aff>
<wicri:noCountry code="subfield">Ga</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Ludwig, Bryan" sort="Ludwig, Bryan" uniqKey="Ludwig B" first="Bryan" last="Ludwig">Bryan Ludwig</name>
<affiliation wicri:level="2"><nlm:aff id="A7">Department of Internal Medicine (Neurology), Miami Valley Hospital, Wright State University, Boonshoft School of Medicine, Dayton, Ohio</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Ohio</region>
</placeName>
<wicri:cityArea>Department of Internal Medicine (Neurology), Miami Valley Hospital, Wright State University, Boonshoft School of Medicine, Dayton</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Clemmons, Paul F" sort="Clemmons, Paul F" uniqKey="Clemmons P" first="Paul F." last="Clemmons">Paul F. Clemmons</name>
<affiliation><nlm:aff id="A10">Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tenn</nlm:aff>
<wicri:noCountry code="subfield">Tenn</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Cronin, Carolyn A" sort="Cronin, Carolyn A" uniqKey="Cronin C" first="Carolyn A." last="Cronin">Carolyn A. Cronin</name>
<affiliation><nlm:aff>NONE</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tian, Melissa" sort="Tian, Melissa" uniqKey="Tian M" first="Melissa" last="Tian">Melissa Tian</name>
<affiliation><nlm:aff id="A3">Department of Neurology, Allegheny General Hospital, Pittsburgh, Pa</nlm:aff>
<wicri:noCountry code="subfield">Pa</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Liebeskind, David" sort="Liebeskind, David" uniqKey="Liebeskind D" first="David" last="Liebeskind">David Liebeskind</name>
<affiliation><nlm:aff id="A11">Department of Neurology, University of California Los Angeles, Los Angeles, Calif</nlm:aff>
<wicri:noCountry code="subfield">Calif</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Zaidat, Osama O" sort="Zaidat, Osama O" uniqKey="Zaidat O" first="Osama O." last="Zaidat">Osama O. Zaidat</name>
<affiliation><nlm:aff id="A12">Department of Neurology, Neurosurgery and Radiology, Medical College of Wisconsin, Milwaukee, Wis</nlm:aff>
<wicri:noCountry code="subfield">Wis</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Castonguay, Alicia C" sort="Castonguay, Alicia C" uniqKey="Castonguay A" first="Alicia C." last="Castonguay">Alicia C. Castonguay</name>
<affiliation><nlm:aff id="A12">Department of Neurology, Neurosurgery and Radiology, Medical College of Wisconsin, Milwaukee, Wis</nlm:aff>
<wicri:noCountry code="subfield">Wis</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Martin, Coleman" sort="Martin, Coleman" uniqKey="Martin C" first="Coleman" last="Martin">Coleman Martin</name>
<affiliation><nlm:aff id="A13">St. Luke’s Kansas City, Kansas City, Mo</nlm:aff>
<wicri:noCountry code="subfield">Mo</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Mueller Kronast, Nils" sort="Mueller Kronast, Nils" uniqKey="Mueller Kronast N" first="Nils" last="Mueller-Kronast">Nils Mueller-Kronast</name>
<affiliation><nlm:aff id="A14">Department of Neurology, Delray Medical Center, Delray Beach, Fla</nlm:aff>
<wicri:noCountry code="subfield">Fla</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="English, Joey D" sort="English, Joey D" uniqKey="English J" first="Joey D." last="English">Joey D. English</name>
<affiliation><nlm:aff id="A15">California Pacific Medical Center, San Francisco, Calif</nlm:aff>
<wicri:noCountry code="subfield">Calif</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Linfante, Italo" sort="Linfante, Italo" uniqKey="Linfante I" first="Italo" last="Linfante">Italo Linfante</name>
<affiliation><nlm:aff id="A16">Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Fla</nlm:aff>
<wicri:noCountry code="subfield">Fla</wicri:noCountry>
</affiliation>
</author>
<author><name sortKey="Malisch, Timothy W" sort="Malisch, Timothy W" uniqKey="Malisch T" first="Timothy W." last="Malisch">Timothy W. Malisch</name>
<affiliation wicri:level="1"><nlm:aff id="A17">Alexian Brothers Medical Center, Elk Grove Village, Ill., USA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Alexian Brothers Medical Center, Elk Grove Village, Ill.</wicri:regionArea>
<wicri:noRegion>Ill.</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Gupta, Rishi" sort="Gupta, Rishi" uniqKey="Gupta R" first="Rishi" last="Gupta">Rishi Gupta</name>
<affiliation><nlm:aff id="A8">Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga</nlm:aff>
<wicri:noCountry code="subfield">Ga</wicri:noCountry>
</affiliation>
</author>
</analytic>
<series><title level="j">Cerebrovascular diseases (Basel, Switzerland)</title>
<idno type="ISSN">1015-9770</idno>
<idno type="eISSN">1421-9786</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">There are multiple clinical and radiographic factors that influence outcomes after endovascular reperfusion therapy (ERT) in acute ischemic stroke (AIS). We sought to derive and validate an outcome prediction score for AIS patients undergoing ERT based on readily available pretreatment and posttreatment factors.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">The derivation cohort included 511 patients with anterior circulation AIS treated with ERT at 10 centers between September 2009 and July 2011. The prospective validation cohort included 223 patients with anterior circulation AIS treated in the North American Solitaire Acute Stroke registry. Multivariable logistic regression identified predictors of good outcome (modified Rankin score ≤2 at 3 months) in the derivation cohort; model β coefficients were used to assign points and calculate a risk score. Discrimination was tested using C statistics with 95% confidence intervals (CIs) in the derivation and validation cohorts. Calibration was assessed using the Hosmer-Lemeshow test and plots of observed to expected outcomes. We assessed the net reclassification improvement for the derived score compared to the Totaled Health Risks in Vascular Events (THRIVE) score. Subgroup analysis in patients with pretreatment Alberta Stroke Program Early CT Score (ASPECTS) and posttreatment final infarct volume measurements was also performed to identify whether these radiographic predictors improved the model compared to simpler models.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Good outcome was noted in 186 (36.4%) and 100 patients (44.8%) in the derivation and validation cohorts, respectively. Combining readily available pretreatment and posttreatment variables, we created a score (acronym: SNARL) based on the following parameters: symptomatic hemorrhage [2 points: none, hemorrhagic infarction (HI)1–2 or parenchymal hematoma (PH) type 1; 0 points: PH2], baseline National Institutes of Health Stroke Scale score (3 points: 0–10; 1 point: 11–20; 0 points: >20), age (2 points: <60 years; 1 point: 60–79 years; 0 points: >79 years), reperfusion (3 points: Thrombolysis In Cerebral Ischemia score 2b or 3) and location of clot (1 point: M2; 0 points: M1 or internal carotid artery). The SNARL score demonstrated good discrimination in the derivation (C statistic 0.79, 95% CI 0.75–0.83) and validation cohorts (C statistic 0.74, 95% CI 0.68–0.81) and was superior to the THRIVE score (derivation cohort: C statistic 0.65, 95% CI 0.60–0.70; validation cohort: C-statistic 0.59, 95% CI 0.52–0.67; p < 0.01 in both cohorts) but was inferior to a score that included age, ASPECTS, reperfusion status and final infarct volume (C statistic 0.86, 95% CI 0.82–0.91; p = 0.04). Compared with the THRIVE score, the SNARL score resulted in a net reclassification improvement of 34.8%.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Among AIS patients treated with ERT, pretreatment scores such as the THRIVE score provide only fair prognostic information. Inclusion of posttreatment variables such as reperfusion and symptomatic hemorrhage greatly influences outcome and results in improved outcome prediction.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9100851</journal-id>
<journal-id journal-id-type="pubmed-jr-id">20932</journal-id>
<journal-id journal-id-type="nlm-ta">Cerebrovasc Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">Cerebrovasc. Dis.</journal-id>
<journal-title-group><journal-title>Cerebrovascular diseases (Basel, Switzerland)</journal-title>
</journal-title-group>
<issn pub-type="ppub">1015-9770</issn>
<issn pub-type="epub">1421-9786</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">24942008</article-id>
<article-id pub-id-type="pmc">4157916</article-id>
<article-id pub-id-type="doi">10.1159/000362591</article-id>
<article-id pub-id-type="manuscript">NIHMS622340</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Posttreatment Variables Improve Outcome Prediction after Intra-Arterial Therapy for Acute Ischemic Stroke</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Prabhakaran</surname>
<given-names>Shyam</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Jovin</surname>
<given-names>Tudor G.</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tayal</surname>
<given-names>Ashis H.</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hussain</surname>
<given-names>Muhammad S.</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nguyen</surname>
<given-names>Thanh N.</given-names>
</name>
<xref ref-type="aff" rid="A5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sheth</surname>
<given-names>Kevin N.</given-names>
</name>
<xref ref-type="aff" rid="A6">f</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Terry</surname>
<given-names>John B.</given-names>
</name>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nogueira</surname>
<given-names>Raul G.</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Horev</surname>
<given-names>Anat</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gandhi</surname>
<given-names>Dheeraj</given-names>
</name>
<xref ref-type="aff" rid="A9">i</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wisco</surname>
<given-names>Dolora</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Glenn</surname>
<given-names>Brenda A.</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ludwig</surname>
<given-names>Bryan</given-names>
</name>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Clemmons</surname>
<given-names>Paul F.</given-names>
</name>
<xref ref-type="aff" rid="A10">j</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cronin</surname>
<given-names>Carolyn A.</given-names>
</name>
<xref ref-type="aff" rid="A9">i</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tian</surname>
<given-names>Melissa</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Liebeskind</surname>
<given-names>David</given-names>
</name>
<xref ref-type="aff" rid="A11">k</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Zaidat</surname>
<given-names>Osama O.</given-names>
</name>
<xref ref-type="aff" rid="A12">l</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Castonguay</surname>
<given-names>Alicia C.</given-names>
</name>
<xref ref-type="aff" rid="A12">l</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Martin</surname>
<given-names>Coleman</given-names>
</name>
<xref ref-type="aff" rid="A13">m</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mueller-Kronast</surname>
<given-names>Nils</given-names>
</name>
<xref ref-type="aff" rid="A14">n</xref>
</contrib>
<contrib contrib-type="author"><name><surname>English</surname>
<given-names>Joey D.</given-names>
</name>
<xref ref-type="aff" rid="A15">o</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Linfante</surname>
<given-names>Italo</given-names>
</name>
<xref ref-type="aff" rid="A16">p</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Malisch</surname>
<given-names>Timothy W.</given-names>
</name>
<xref ref-type="aff" rid="A17">q</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gupta</surname>
<given-names>Rishi</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Ill</aff>
<aff id="A2"><label>b</label>
Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center</aff>
<aff id="A3"><label>c</label>
Department of Neurology, Allegheny General Hospital, Pittsburgh, Pa</aff>
<aff id="A4"><label>d</label>
Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, Ohio</aff>
<aff id="A5"><label>e</label>
Departments of Neurology and Radiology, Boston University School of Medicine, Boston, Mass</aff>
<aff id="A6"><label>f</label>
Department of Neurology, Yale University School of Medicine, New Haven, Conn</aff>
<aff id="A7"><label>g</label>
Department of Internal Medicine (Neurology), Miami Valley Hospital, Wright State University, Boonshoft School of Medicine, Dayton, Ohio</aff>
<aff id="A8"><label>h</label>
Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Ga</aff>
<aff id="A9"><label>I</label>
Department of Neurology, University of Maryland School of Medicine, Baltimore, Md</aff>
<aff id="A10"><label>j</label>
Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tenn</aff>
<aff id="A11"><label>k</label>
Department of Neurology, University of California Los Angeles, Los Angeles, Calif</aff>
<aff id="A12"><label>l</label>
Department of Neurology, Neurosurgery and Radiology, Medical College of Wisconsin, Milwaukee, Wis</aff>
<aff id="A13"><label>m</label>
St. Luke’s Kansas City, Kansas City, Mo</aff>
<aff id="A14"><label>n</label>
Department of Neurology, Delray Medical Center, Delray Beach, Fla</aff>
<aff id="A15"><label>o</label>
California Pacific Medical Center, San Francisco, Calif</aff>
<aff id="A16"><label>p</label>
Division of Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, Miami, Fla</aff>
<aff id="A17"><label>q</label>
Alexian Brothers Medical Center, Elk Grove Village, Ill., USA</aff>
<author-notes><corresp id="FN1">Shyam Prabhakaran, MD, Suite 1417, 710 N. Lake Shore Dr., Chicago, IL 60611 (USA), <email>shyam.prabhakaran@northwestern.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>21</day>
<month>8</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="epub"><day>18</day>
<month>6</month>
<year>2014</year>
</pub-date>
<pub-date pub-type="ppub"><year>2014</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>08</day>
<month>9</month>
<year>2014</year>
</pub-date>
<volume>37</volume>
<issue>5</issue>
<fpage>356</fpage>
<lpage>363</lpage>
<pmc-comment>elocation-id from pubmed: 10.1159/000362591</pmc-comment>
<permissions><copyright-statement>© 2014 S. Karger AG, Basel</copyright-statement>
<copyright-year>2014</copyright-year>
</permissions>
<abstract><sec id="S1"><title>Background</title>
<p id="P1">There are multiple clinical and radiographic factors that influence outcomes after endovascular reperfusion therapy (ERT) in acute ischemic stroke (AIS). We sought to derive and validate an outcome prediction score for AIS patients undergoing ERT based on readily available pretreatment and posttreatment factors.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">The derivation cohort included 511 patients with anterior circulation AIS treated with ERT at 10 centers between September 2009 and July 2011. The prospective validation cohort included 223 patients with anterior circulation AIS treated in the North American Solitaire Acute Stroke registry. Multivariable logistic regression identified predictors of good outcome (modified Rankin score ≤2 at 3 months) in the derivation cohort; model β coefficients were used to assign points and calculate a risk score. Discrimination was tested using C statistics with 95% confidence intervals (CIs) in the derivation and validation cohorts. Calibration was assessed using the Hosmer-Lemeshow test and plots of observed to expected outcomes. We assessed the net reclassification improvement for the derived score compared to the Totaled Health Risks in Vascular Events (THRIVE) score. Subgroup analysis in patients with pretreatment Alberta Stroke Program Early CT Score (ASPECTS) and posttreatment final infarct volume measurements was also performed to identify whether these radiographic predictors improved the model compared to simpler models.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Good outcome was noted in 186 (36.4%) and 100 patients (44.8%) in the derivation and validation cohorts, respectively. Combining readily available pretreatment and posttreatment variables, we created a score (acronym: SNARL) based on the following parameters: symptomatic hemorrhage [2 points: none, hemorrhagic infarction (HI)1–2 or parenchymal hematoma (PH) type 1; 0 points: PH2], baseline National Institutes of Health Stroke Scale score (3 points: 0–10; 1 point: 11–20; 0 points: >20), age (2 points: <60 years; 1 point: 60–79 years; 0 points: >79 years), reperfusion (3 points: Thrombolysis In Cerebral Ischemia score 2b or 3) and location of clot (1 point: M2; 0 points: M1 or internal carotid artery). The SNARL score demonstrated good discrimination in the derivation (C statistic 0.79, 95% CI 0.75–0.83) and validation cohorts (C statistic 0.74, 95% CI 0.68–0.81) and was superior to the THRIVE score (derivation cohort: C statistic 0.65, 95% CI 0.60–0.70; validation cohort: C-statistic 0.59, 95% CI 0.52–0.67; p < 0.01 in both cohorts) but was inferior to a score that included age, ASPECTS, reperfusion status and final infarct volume (C statistic 0.86, 95% CI 0.82–0.91; p = 0.04). Compared with the THRIVE score, the SNARL score resulted in a net reclassification improvement of 34.8%.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Among AIS patients treated with ERT, pretreatment scores such as the THRIVE score provide only fair prognostic information. Inclusion of posttreatment variables such as reperfusion and symptomatic hemorrhage greatly influences outcome and results in improved outcome prediction.</p>
</sec>
</abstract>
<kwd-group><kwd>Prediction tools</kwd>
<kwd>Revascularization</kwd>
<kwd>Reperfusion</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Ohio</li>
</region>
</list>
<tree><noCountry><name sortKey="Castonguay, Alicia C" sort="Castonguay, Alicia C" uniqKey="Castonguay A" first="Alicia C." last="Castonguay">Alicia C. Castonguay</name>
<name sortKey="Clemmons, Paul F" sort="Clemmons, Paul F" uniqKey="Clemmons P" first="Paul F." last="Clemmons">Paul F. Clemmons</name>
<name sortKey="Cronin, Carolyn A" sort="Cronin, Carolyn A" uniqKey="Cronin C" first="Carolyn A." last="Cronin">Carolyn A. Cronin</name>
<name sortKey="English, Joey D" sort="English, Joey D" uniqKey="English J" first="Joey D." last="English">Joey D. English</name>
<name sortKey="Gandhi, Dheeraj" sort="Gandhi, Dheeraj" uniqKey="Gandhi D" first="Dheeraj" last="Gandhi">Dheeraj Gandhi</name>
<name sortKey="Glenn, Brenda A" sort="Glenn, Brenda A" uniqKey="Glenn B" first="Brenda A." last="Glenn">Brenda A. Glenn</name>
<name sortKey="Gupta, Rishi" sort="Gupta, Rishi" uniqKey="Gupta R" first="Rishi" last="Gupta">Rishi Gupta</name>
<name sortKey="Horev, Anat" sort="Horev, Anat" uniqKey="Horev A" first="Anat" last="Horev">Anat Horev</name>
<name sortKey="Jovin, Tudor G" sort="Jovin, Tudor G" uniqKey="Jovin T" first="Tudor G." last="Jovin">Tudor G. Jovin</name>
<name sortKey="Liebeskind, David" sort="Liebeskind, David" uniqKey="Liebeskind D" first="David" last="Liebeskind">David Liebeskind</name>
<name sortKey="Linfante, Italo" sort="Linfante, Italo" uniqKey="Linfante I" first="Italo" last="Linfante">Italo Linfante</name>
<name sortKey="Martin, Coleman" sort="Martin, Coleman" uniqKey="Martin C" first="Coleman" last="Martin">Coleman Martin</name>
<name sortKey="Mueller Kronast, Nils" sort="Mueller Kronast, Nils" uniqKey="Mueller Kronast N" first="Nils" last="Mueller-Kronast">Nils Mueller-Kronast</name>
<name sortKey="Nguyen, Thanh N" sort="Nguyen, Thanh N" uniqKey="Nguyen T" first="Thanh N." last="Nguyen">Thanh N. Nguyen</name>
<name sortKey="Nogueira, Raul G" sort="Nogueira, Raul G" uniqKey="Nogueira R" first="Raul G." last="Nogueira">Raul G. Nogueira</name>
<name sortKey="Prabhakaran, Shyam" sort="Prabhakaran, Shyam" uniqKey="Prabhakaran S" first="Shyam" last="Prabhakaran">Shyam Prabhakaran</name>
<name sortKey="Sheth, Kevin N" sort="Sheth, Kevin N" uniqKey="Sheth K" first="Kevin N." last="Sheth">Kevin N. Sheth</name>
<name sortKey="Tayal, Ashis H" sort="Tayal, Ashis H" uniqKey="Tayal A" first="Ashis H." last="Tayal">Ashis H. Tayal</name>
<name sortKey="Tian, Melissa" sort="Tian, Melissa" uniqKey="Tian M" first="Melissa" last="Tian">Melissa Tian</name>
<name sortKey="Zaidat, Osama O" sort="Zaidat, Osama O" uniqKey="Zaidat O" first="Osama O." last="Zaidat">Osama O. Zaidat</name>
</noCountry>
<country name="États-Unis"><region name="Ohio"><name sortKey="Hussain, Muhammad S" sort="Hussain, Muhammad S" uniqKey="Hussain M" first="Muhammad S." last="Hussain">Muhammad S. Hussain</name>
</region>
<name sortKey="Ludwig, Bryan" sort="Ludwig, Bryan" uniqKey="Ludwig B" first="Bryan" last="Ludwig">Bryan Ludwig</name>
<name sortKey="Malisch, Timothy W" sort="Malisch, Timothy W" uniqKey="Malisch T" first="Timothy W." last="Malisch">Timothy W. Malisch</name>
<name sortKey="Terry, John B" sort="Terry, John B" uniqKey="Terry J" first="John B." last="Terry">John B. Terry</name>
<name sortKey="Wisco, Dolora" sort="Wisco, Dolora" uniqKey="Wisco D" first="Dolora" last="Wisco">Dolora Wisco</name>
</country>
</tree>
</affiliations>
</record>
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