Independent external validation of a stroke recurrence score in patients with embolic stroke of undetermined source
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Published:2023-10-05
Issue:1
Volume:5
Page:
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ISSN:2524-3489
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Container-title:Neurological Research and Practice
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language:en
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Short-container-title:Neurol. Res. Pract.
Author:
Ingwersen ThiesORCID, Olma Manuel C., Schlemm Eckhard, Mayer Carola, Cheng Bastian, Tütüncü Serdar, Kirchhof Paulus, Veltkamp Roland, Röther Joachim, Laufs Ulrich, Nabavi Darius G., Ntaios George, Endres Matthias, Haeusler Karl Georg, Thomalla Götz
Abstract
Abstract
Background
Embolic stroke of undetermined source (ESUS) accounts for a substantial proportion of ischaemic strokes. A stroke recurrence score has been shown to predict the risk of recurrent stroke in patients with ESUS based on a combination of clinical and imaging features. This study aimed to externally validate the performance of the ESUS recurrence score using data from a randomized controlled trial.
Methods
The validation dataset consisted of eligible stroke patients with available magnetic resonance imaging (MRI) data enrolled in the PreDAFIS sub-study of the MonDAFIS study. The score was calculated using three variables: age (1 point per decade after 35 years), presence of white matter hyperintensities (2 points), and multiterritorial ischaemic stroke (3 points). Patients were assigned to risk groups as described in the original publication. The model was evaluated using standard discrimination and calibration methods.
Results
Of the 1054 patients, 241 (22.9%) were classified as ESUS. Owing to insufficient MRI quality, three patients were excluded, leaving 238 patients (median age 65.5 years [IQR 20.75], 39% female) for analysis. Of these, 30 (13%) patients experienced recurrent ischaemic stroke or transient ischemic attack (TIA) during a follow-up period of 383 patient-years, corresponding to an incidence rate of 7.8 per 100 patient-years (95% CI 5.3–11.2). Patients with an ESUS recurrence score value of ≥ 7 had a 2.46 (hazard ratio (HR), 95% CI 1.02–5.93) times higher risk of stroke recurrence than patients with a score of 0–4. The cumulative probability of stroke recurrence in the low-(0–4), intermediate-(5–6), and high-risk group (≥ 7) was 9%, 13%, and 23%, respectively (log-rank test, χ2 = 4.2, p = 0.1).
Conclusions
This external validation of a published scoring system supports a threshold of ≥ 7 for identifying ESUS patients at high-risk of stroke recurrence. However, further adjustments may be required to improve the model’s performance in independent cohorts. The use of risk scores may be helpful in guiding extended diagnostics and further trials on secondary prevention in patients with ESUS.
Trial registration: Clinical Trials, NCT02204267. Registered 30 July 2014, https://clinicaltrials.gov/ct2/show/NCT02204267.
Funder
Bayer Vital Universitätsklinikum Hamburg-Eppendorf (UKE)
Publisher
Springer Science and Business Media LLC
Subject
Neurology (clinical),Neurology
Reference28 articles.
1. Collins, G. S., de Groot, J. A., Dutton, S., Omar, O., Shanyinde, M., Tajar, A., Voysey, M., Wharton, R., Yu, L.-M., Moons, K. G., & Altman, D. G. (2014). External validation of multivariable prediction models: A systematic review of methodological conduct and reporting. BMC Medical Research Methodology, 14(1), 40. https://doi.org/10.1186/1471-2288-14-40 2. Dawson, J., Béjot, Y., Christensen, L. M., De Marchis, G. M., Dichgans, M., Hagberg, G., Heldner, M. R., Milionis, H., Li, L., Pezzella, F. R., Taylor Rowan, M., Tiu, C., & Webb, A. (2022). European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack. European Stroke Journal, 7(3), I–XLI. https://doi.org/10.1177/23969873221100032 3. Diener, H.-C., Easton, J. D., Hart, R. G., Kasner, S., Kamel, H., & Ntaios, G. (2022). Review and update of the concept of embolic stroke of undetermined source. Nature Reviews Neurology, 18(8), 455–465. https://doi.org/10.1038/s41582-022-00663-4 4. Diener, H.-C., Sacco, R. L., Easton, J. D., Granger, C. B., Bar, M., Bernstein, R. A., Brainin, M., Brueckmann, M., Cronin, L., Donnan, G., Gdovinová, Z., Grauer, C., Kleine, E., Kleinig, T. J., Lyrer, P., Martins, S., Meyerhoff, J., Milling, T., Pfeilschifter, W., … Schäbitz, W.-R. (2020). Antithrombotic treatment of embolic stroke of undetermined source: RE-SPECT ESUS elderly and renally impaired subgroups. Stroke, 51(6), 1758–1765. https://doi.org/10.1161/STROKEAHA.119.028643 5. Diener, H.-C., Sacco, R. L., Easton, J. D., Granger, C. B., Bernstein, R. A., Uchiyama, S., Kreuzer, J., Cronin, L., Cotton, D., Grauer, C., Brueckmann, M., Chernyatina, M., Donnan, G., Ferro, J. M., Grond, M., Kallmünzer, B., Krupinski, J., Lee, B.-C., Lemmens, R., … Toyoda, K. (2019). Dabigatran for prevention of stroke after embolic stroke of undetermined source. New England Journal of Medicine, 380(20), 1906–1917. https://doi.org/10.1056/NEJMoa1813959
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