Outcome Prediction Models for Endovascular Treatment of Ischemic Stroke: Systematic Review and External Validation
Author:
Kremers Femke1ORCID, Venema Esmee12ORCID, Duvekot Martijne13ORCID, Yo Lonneke4, Bokkers Reinoud5ORCID, Lycklama À. Nijeholt Geert6, van Es Adriaan7, van der Lugt Aad8, Majoie Charles9, Burke James10, Roozenbeek Bob1, Lingsma Hester2, Dippel Diederik1, der Lugt Aad van, Roos Yvo B.W.E.M., van Oostenbrugge Robert J., van Zwam Wim H., Boiten Jelis, Vos Jan Albert, Jansen Ivo G.H., Mulder Maxim J.H.L., Goldhoorn Robert- Jan B., Compagne Kars C.J., Kappelhof Manon, Brouwer Josje, den Hartog Sanne J., Hinsenveld Wouter H., Roos Yvo B.W.E.M., Emmer Bart J., Coutinho Jonathan M., Schonewille Wouter J., Vos Jan Albert, Wermer Marieke J.H., van Walderveen Marianne A.A., Staals Julie, van Oostenbrugge Robert J., van Zwam Wim H., Hofmeijer Jeannette, Martens Jasper M., Boiten Jelis, de Bruijn Sebastiaan F., van Dijk Lukas C., van der Worp H. Bart, Lo Rob H., van Dijk Ewoud J., Boogaarts Hieronymus D., Vries J. de, de Kort Paul L.M., van Tuijl Julia, Peluso Jo P., Fransen Puck, van den Berg Jan S.P., van Hasselt Boudewijn A.A.M., Aerden Leo A.M., Dallinga René J., Uyttenboogaart Maarten, Eschgi Omid, Schreuder Tobien H.C.M.L., Heijboer Roel J.J., Keizer Koos, den Hertog Heleen M., Sturm Emiel J.C., Brouwers Paul J.A.M., van Zwam Wim H., der Lugt Aad van, Boiten Jelis, de Bruijn Sebastiaan F., van Dijk Lukas C., van der Worp H. Bart, Lo Rob H., van Dijk Ewoud J., Boogaarts Hieronymus D., de Vries J., de Kort Paul L.M., van Tuijl Julia, Peluso Jo P., Fransen Puck, van den Berg Jan S.P., van Hasselt Boudewijn A.A.M., Aerden Leo A.M., Dallinga René J., Uyttenboogaart Maarten, Eschgi Omid, Schreuder Tobien H.C.M.L., Heijboer Roel J.J., Keizer Koos, den Hertog Heleen M., Sturm Heleen M., Brouwers Paul J.A.M., van Zwam Wim H., van Walderveen MarianneA.A, Sprengers Marieke E.S., Jenniskens Sjoerd F.M., van den Berg René, Yoo Albert J., Beenen Ludo F.M., Postma Alida A., Roosendaal Stefan D., van der Kallen Bas F.W., van den Wijngaard Ido R., Emmer Bart J., Martens Jasper M., Vos Jan Albert, Bot Joost, van Doormaal Pieter-Jan, Meijer Anton, Ghariq Elyas, van Proosdij Marc P., Krietemeijer G. Menno, Peluso Jo P., Boogaarts Hieronymus D., Lo Rob, Gerrits Dick, Dinkelaar Wouter, Appelman Auke P.A., Hammer Bas, Pegge Sjoert, van der Hoorn Anouk, Vinke Saman, Roos Yvo B.W.E.M., van Oostenbrugge Robert J., van Zwam Wim H., Boiten Jelis, Vos Jan Albert, Schonewille Wouter J., Hofmeijer Jeannette, Martens Jasper M., van der Worp H. Bart, Lo Rob H., van Oostenbrugge Robert J., Hofmeijer Jeannette, Flach H. Zwenneke, Ghannouti Naziha el, Sterrenberg Martin, Pellikaan Wilma, Sprengers Rita, Elfrink Marjan, Simons Michelle, Vossers Marjolein, de Meris Joke, Vermeulen Tamara, Geerlings Annet, van Vemde Gina, Simons Tiny, Messchendorp Gert, Nicolaij Nynke, Bongenaar Hester, Bodde Karin, Kleijn Sandra, Lodico Jasmijn, Droste Hanneke, Wollaert Maureen, Verheesen Sabrina, Jeurrissen D., Bos Erna, Drabbe Yvonne, Sandiman Michelle, Aaldering Nicoline, Zweedijk Berber, Vervoort Jocova, Ponjee Eva, Romviel Sharon, Kanselaar Karin, Barning Denn, Chalos Vicky, Geuskens Ralph R., van Straaten Tim, Ergezen Saliha, Harmsma Roger R.M., Muijres Daan, de Jong Anouk, Berkhemer Olvert A., Boers3 Anna M.M., Huguet J., Groot P.F.C., Mens Marieke A., van Kranendonk Katinka R., Treurniet Kilian M., Tolhuisen Manon L., Alves Heitor, Weterings Annick J., Kirkels Eleonora L.F., Voogd Eva J.H.F., Schupp Lieve M., Collette Sabine L., Groot Adrien E.D., LeCouffe Natalie E., Konduri Praneeta R., Prasetya Haryadi, Arrarte- Terreros Nerea, Ramos Lucas A.
Affiliation:
1. Neurology, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands (F.K., E.V., M.D., B.R., D.D.). 2. Public Health, Erasmus Medical Center, Rotterdam, the Netherlands (E.V., H.L.). 3. Neurology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (M.D.). 4. Radiology, Catharina Medical Center, Eindhoven, the Netherlands (L.Y.). 5. Radiology, UMCG Groningen Medical Center, the Netherlands (R.B.). 6. Radiology, Haaglanden Medical Center, The Hague, the Netherlands (G.L.A.N.). 7. Radiology, Leiden Medical Center, the Netherlands (A.v.E.). 8. Radiology, Erasmus Medical Center, Rotterdam, the Netherlands (A.v.d.L.). 9. Radiology, Amsterdam Medical Center, the Netherlands (C.M.). 10. Neurology, University of Michigan, Ann Arbor (J.B.).
Abstract
Background and Purpose:
Prediction models for outcome of patients with acute ischemic stroke who will undergo endovascular treatment have been developed to improve patient management. The aim of the current study is to provide an overview of preintervention models for functional outcome after endovascular treatment and to validate these models with data from daily clinical practice.
Methods:
We systematically searched within Medline, Embase, Cochrane, Web of Science, to include prediction models. Models identified from the search were validated in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) registry, which includes all patients treated with endovascular treatment within 6.5 hours after stroke onset in the Netherlands between March 2014 and November 2017. Predictive performance was evaluated according to discrimination (area under the curve) and calibration (slope and intercept of the calibration curve). Good functional outcome was defined as a score of 0–2 or 0–3 on the modified Rankin Scale depending on the model.
Results:
After screening 3468 publications, 19 models were included in this validation. Variables included in the models mainly addressed clinical and imaging characteristics at baseline. In the validation cohort of 3156 patients, discriminative performance ranged from 0.61 (SPAN-100 [Stroke Prognostication Using Age and NIH Stroke Scale]) to 0.80 (MR PREDICTS). Best-calibrated models were THRIVE (The Totaled Health Risks in Vascular Events; intercept −0.06 [95% CI, −0.14 to 0.02]; slope 0.84 [95% CI, 0.75–0.95]), THRIVE-c (intercept 0.08 [95% CI, −0.02 to 0.17]; slope 0.71 [95% CI, 0.65–0.77]), Stroke Checkerboard score (intercept −0.05 [95% CI, −0.13 to 0.03]; slope 0.97 [95% CI, 0.88–1.08]), and MR PREDICTS (intercept 0.43 [95% CI, 0.33–0.52]; slope 0.93 [95% CI, 0.85–1.01]).
Conclusions:
The THRIVE-c score and MR PREDICTS both showed a good combination of discrimination and calibration and were, therefore, superior in predicting functional outcome for patients with ischemic stroke after endovascular treatment within 6.5 hours. Since models used different predictors and several models had relatively good predictive performance, the decision on which model to use in practice may also depend on simplicity of the model, data availability, and the comparability of the population and setting.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
25 articles.
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