The Predictive Value of Essen and SPI-II on the Risk of 5-Year Recurrence in Chinese Patients with Acute Ischemic Stroke

Background

The risk prediction score for stroke recurrence is an important tool for stratifying patients based on the risk of cerebrovascular events and selecting potential preventive treatments.

Objective

The study aimed to validate the Essen Stroke Risk Score (ESRS) and Stroke Prognosis Instrument II (SPI-II) for predicting long-term risk of stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke (AIS).

Methods

A total of 876 consecutive patients with non-atrial fibrillation AIS were recruited. The Kaplan-Meier (KM) method was used to estimate the cumulative incidence of stroke recurrence and combined vascular events in different subgroups stratified by the ESRS and SPI-II scores. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of the two scores for stroke recurrence and combined vascular events.

Results

The KM estimate for 5-year cumulative incidence of stroke recurrence and combined vascular events was 28.7% (95% confidence interval [CI], 25.4-32.0) and 35.6% (95% CI, 32.3-38.9), respectively, in Chinese AIS patients. The risk of stroke recurrence and combined vascular events were increased significantly with increasing ESRS and SPI-II scores. The ESRS and SPI-II scores had similar predictive accuracy for stroke recurrence (AUC 0.57 [95% CI 0.52-0.64] vs 0.59 [95% CI 0.55-0.64]) and combined vascular events (AUC 0.59 [95% CI 0.55-0.63] vs 0.62 [95% CI 0.58-0.66]) at 5 years.

Conclusion

In Chinese patients with AIS, both ESRS and SPI-II scores were able to stratify the risk of 5-year recurrent stroke and combined vascular events. The predictive power of the two scores were modest and a prediction model suitable for Chinese IS populations is needed.

Inner diameters of the normal carotid arteries measured using three-dimensional digital subtraction catheter angiography: a retrospective analysis

Purpose

To obtain normal ranges for the inner diameters of the carotid arteries.

Methods

This retrospective analysis included consecutive patients with disease-free carotid arteries who had undergone 3D-DSA at two hospitals in Nanning, Guangxi, between March 2013 and March 2018. Demographic and clinical characteristics, including Essen Stroke Risk Score (ESRS), were extracted from the medical records. The 3D-DSA data were used to calculate the inner diameters of the carotid arteries.

Results

The analysis included 1182 patients (837 males) aged 58.81 ± 11.02 years. The inner diameters of the proximal carotid sinus (CS), CS bulge, distal CS, and common carotid artery (CCA) were larger on the right than on the left (P < 0.05). The inner diameters of the proximal CS, CS bulge, distal CS, and CCA on both sides were larger for males than females (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients aged > 65 years than for patients aged ≤ 55 years (P < 0.05). Right CCA inner diameter did not vary with age, whereas left CCA inner diameter was larger for patients aged > 55 years than for patients aged ≤ 45 years (P < 0.05). The inner diameters of the proximal CS, CS bulge, and distal CS on both sides were smaller for patients with ESRS ≥ 3 than those with ESRS < 3 (P < 0.05).

Conclusion

This study provides reference values for the internal diameters of normal carotid arteries. Carotid artery diameters varied with side, sex, and age.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02328-z.

Essen Stroke Risk Score Predicts Carotid Atherosclerosis in Chinese Community Populations

BACKGROUND

Carotid atherosclerosis (CA) is closely related to stroke, and Framingham Risk Score (FRS) has been used for CA risk evaluation. However, FRS could only be used for subjects of up to 74 years old. The present study was to determine if Essen Stroke Risk Score (ESRS) could be used to estimate CA risk in community populations without age limits.

METHODS

In the present prospective multi-community screening study, we evaluated the prevalence of CA using high-resolution ultrasound in 521 males and 1039 females (35 to 91 years old). Both FRS and ESRS were calculated for the subjects. Multivariate logistic regression analysis was used to determine the predictive values of FRS and ESRS for CA in these subjects.

RESULTS

Ultrasound data showed that CA was present in 56.2% of the participants (total of 1560). Multivariate logistic regression analysis showed that ESRS was associated with CA with odds ratio (OR): 1.34 (95% confidence interval (CI), 1.12-1.60, p=0.001). Central obesity (OR: 1.40, CI: 1.07-1.83, p=0.015), female (OR: 0.55, CI: 0.39-0.77, p <0.001) and age (OR: 2.63, CI: 2.27-3.06, p <0.001) were also associated with CA. Based on the estimated area under curve (AUC), FRS (AUC 0.775) was better than ESRS (AUC 0.693) (z statistic 6.774, p <0.001) for CA prediction for individuals of ≤74 years old. However, receiver operating characteristic analysis showed ESRS was a good CA predictor for all subjects (AUC of 0.715).

CONCLUSION

ESRS could be used as an alternative to FRS to predict CA in community population of all age.

An analysis of the risk of perioperative ischemic stroke in patients undergoing non-cardiovascular and non-neurological surgeries

Objectives: This study aimed to assess the preoperative risk factor for perioperative ischemic stroke (PIS) in patients undergoing non-cardiovascular and non-neurological surgeries.Methods: Patients were retrospectively enrolled and grouped into two groups at a ratio of 1:2 according to their PIS status, i.e. patients with PIS in disease group, and patients without PIS in control group. Univariate analysis and multivariate logistic regression analysis were performed on admission laboratory test indices and preoperative risk factors for stroke. The pooled cohort equation (PCE), Essen Stroke Risk Score (ESRS), and Stroke Prognostic Instrument II (SPI-II) were used to separately assess the risk of stroke in patients with or without a history of stroke.Results: There were significant differences between the two groups in the levels of high-density lipoprotein cholesterol (HDL-C), prealbumin, renal insufficiency, dyslipidemia, coronary heart disease, anemia, and hemoglobin; the incidence of electrolyte disturbance; and previous histories of smoking, drinking, and stroke. Multivariate logistic regression analysis showed that renal insufficiency, histories of smoking and stroke, and decreased HDL-C can increase the risk of PIS. There were no significant differences between the disease group and the control group in ESRS or SPI-II score in patients with stroke history. There was a significant difference between the two groups in the risk of PIS evaluated by PCE in patients without stroke history.Conclusions: History of stroke and smoking, renal insufficiency, and low HDL-C are independent risk factors for PIS. It is feasible to assess the risk of stroke in preoperative patients using PCE in clinical practice.

Antiplatelet Strategies and Outcomes in Patients with Noncardioembolic Ischemic Stroke from a Real-World Study with a Five-Year Follow-Up

Aspirin and clopidogrel are both acceptable antiplatelet options for the secondary prevention of noncardioembolic ischemic stroke. Associations between Essen Stroke Risk Score (ESRS) and antiplatelet treatment in Chinese patients with noncardioembolic ischemic stroke were assessed. This retrospective study was taken in a tertiary care hospital located in eastern China. Patients with noncardioembolic ischemic stroke hospitalized during January 1, 2009, to December 31, 2011, were classified according to ESRS during index stroke hospitalization. Antiplatelet strategy at the time of discharge was categorized as aspirin (100 mg/day) vs. clopidogrel (75 mg/day). Patients received follow-up from July 1, 2014, to December 31, 2015, and the efficacy of clopidogrel and aspirin in different ESRS subgroups was assessed with respect to reducing the risk of a combined vascular event of recurrent stroke, myocardial infarction, or primary intracranial hemorrhage. Totally, 1175 non-cardiac stroke patients were included, among which 878 patients completed follow-up surveys. Of the patients who completed the follow-up, 458 (52.2%) had an ESRS > 3, and 621 (70.7%) received aspirin. Patients who received clopidogrel tended to be older, and more patients had hypertension, diabetes, and an ESRS > 3 than patients who received aspirin. Over a mean follow-up of 5.2 years, the rate of combined vascular events was 19.3% in the aspirin group and 16.7% in the clopidogrel group. Compared with clopidogrel-treated patients, a significant (P = 0.044) reduction in combined vascular events in aspirin-treated patients was observed in patients with an ESRS ≤ 3 (OR, odds ratio 0.5; 95% CI 0.3 to 0.9). However, a significant (P = 0.002) increase in combined vascular events was observed in patients with an ESRS > 3 (OR 2.2; 95% CI 1.3 to 3.8). More clopidogrel-treated patients with ESRS < 3 and ESRS = 3 discontinued treatment than their counterparts who took aspirin (P < 0.05). Adverse drug events, such as digestive discomfort and bleeding, were similar. In conclusion, clopidogrel is suggested for patients with an ESRS > 3 and aspirin for patients with an ESRS ≤ 3 for the secondary prevention of noncardioembolic ischemic stroke in Chinese patients.

Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort

BACKGROUND AND PURPOSE

The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation.

METHODS

We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks.

RESULTS

42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores.

CONCLUSIONS

In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application.