Comparing the Prognostic Impact of Age and Baseline National Institutes of Health Stroke Scale in Acute Stroke due to Large Vessel Occlusion-Reference-Cited by-同舟云学术

Comparing the Prognostic Impact of Age and Baseline National Institutes of Health Stroke Scale in Acute Stroke due to Large Vessel Occlusion

Published:2021-09 Issue:9 Volume:52 Page:2839-2845
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Ospel Johanna Maria¹²,Brown Scott³,Kappelhof Manon⁴,van Zwam Wim⁵,Jovin Tudor⁶,Roy Daniel⁷^ORCID,Campbell Bruce C.V.⁸,Mitchell Peter⁹,Roos Yvo¹⁰,Guillemin Francis¹¹,Buck Brian¹²,Muir Keith¹³,Bracard Serge¹⁴,White Phil¹⁵,du Mesnil de Rochemont Richard¹⁶,Goyal Mayank¹¹⁷^ORCID,

Affiliation:

1. Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Alberta, Canada.

2. Department of Neuroradiology, University Hospital Basel, Switzerland (J.M.O.).

3. Altair Biostatistics, St Louis Park, MN (S.B.).

4. Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands (M.K.).

5. Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht, School for Mental Health and Sciences, Maastricht University Medical Center, the Netherlands (W.v.Z.).

6. Department of Neurology, University of Pittsburgh, PA (T.J.).

7. Centre Hospitalier de l’Université de Montréal, Canada (D.R.).

8. Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (B.C.V.C.).

9. Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia (P.M.).

10. Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (Y.R.).

11. Department of Clinical Epidemiology, Université de Lorraine, University Hospital of Nancy, France (F.G.).

12. University of Alberta Hospital, Edmonton, Canada (B.B.).

13. Institute of Neuroscience and Psychology, University of Glasgow, Scotland (K.M.).

14. Department of Radiology, Université de Lorraine, Nancy, France (S.B.).

15. Department of Radiology, Newcastle University, Newcastle Upon Tyne, United Kingdom (P.W.).

16. Department of Neuroradiology, University Hospital Frankfurt, Germany (R.d.M.d.R.).

17. Department of Radiology (M.G.), University of Calgary, Alberta, Canada.

Abstract

Background and Purpose: Little is known about the combined effect of age and National Institutes of Health Stroke Scale (NIHSS) in endovascular treatment (EVT) for acute ischemic stroke due to large vessel occlusion, and it is not clear how the effects of baseline age and NIHSS on outcome compare to each other. The previously described Stroke Prognostication Using Age and NIHSS (SPAN) index adds up NIHSS and age to a 1:1 combined prognostic index. We added a weighting factor to the NIHSS/age SPAN index to compare the relative prognostic impact of NIHSS and age and assessed EVT effect based on weighted age and NIHSS. Methods: We performed adjusted logistic regression with good outcome (90-day modified Rankin Scale score 0–2) as primary outcome. From this model, the coefficients for NIHSS and age were obtained. The ratio between the NIHSS and age coefficients was calculated to determine a weighted SPAN index. We obtained adjusted effect size estimates for EVT in patient subgroups defined by weighted SPAN increments of 3, to evaluate potential changes in treatment effect. Results: We included 1750/1766 patients from the HERMES collaboration (Highly Effective Reperfusion Using Multiple Endovascular Devices) with available age and NIHSS data. Median NIHSS was 17 (interquartile range, 13–21), and median age was 68 (interquartile range, 57–76). Good outcome was achieved by 682/1743 (39%) patients. The NIHSS/age effect coefficient ratio was ([−0.0032]/[−0.111])=3.4, which was rounded to 3, resulting in a weighted SPAN index defined as ([3×NIHSS]+age). Cumulative EVT effect size estimates across weighted SPAN subgroups consistently favored EVT, with a number needed to treat ranging from 5.3 to 8.7. Conclusions: The impact on chance of good outcome of a 1-point increase in NIHSS roughly corresponded to a 3-year increase in patient age. EVT was beneficial across all weighted age/NIHSS subgroups.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.032364

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