Department of Biostatistics, Graduate School of Medicine, Kurume University, Kurume, Japan.
Int J Stroke. 2013 Jun;8(4):251-7. doi: 10.1111/j.1747-4949.2012.00841.x. Epub 2012 Jul 3.
The Essen stroke risk score is widely applied to predict the risk of recurrent ischemic stroke. We developed a modified Essen stroke risk score and validated it using a large prospective Effective Vascular Event REduction after STroke (EVEREST) registry including 3588 patients with ischemic stroke in Japan. Patients with cardioembolic stroke were excluded, and follow-up was one-year.
The modified Essen stroke risk score was calculated from scores for waist circumference, stroke subtype by etiology, and gender in addition to age, hypertension, diabetes mellitus, previous myocardial infarction, other cardiovascular diseases except myocardial infarction and atrial fibrillation, peripheral artery disease, smoking, and previous stroke or transient ischemic attack. A multiple logistic regression model identified the predictors (each assigned one or two points) and provided c-statistics for the modified Essen stroke risk score. We considered two outcomes, recurrent ischemic stroke and cardiovascular events (defined as the combined outcomes of fatal or nonfatal stroke, myocardial infarction, nonfatal unstable angina, and cardiac death).
Recurrent ischemic stroke occurred in 121 patients (3·7%) and cardiovascular events occurred in 133 (4·0%) within a year. The c-statistic (used for discrimination) was 0·632 for recurrent stroke and 0·640 for cardiovascular events. Patients scoring 6 or greater were classified as high risk, otherwise were classified as low risk. Kaplan-Meier analysis revealed that the modified risk score was more predictive than the Essen stroke risk score in both men and women.
The modified Essen stroke risk score increased the ability of the Essen stroke risk score to predict recurrent cardiovascular events. Patients with a high modified Essen stroke risk score should be candidates for intensified secondary prevention strategies.
Essen 卒中风险评分广泛用于预测复发性缺血性卒中的风险。我们开发了一种改良的 Essen 卒中风险评分，并使用包括日本 3588 例缺血性卒中患者的大型前瞻性有效血管事件预防后卒中（EVEREST）登记研究对其进行了验证。排除了心源性栓塞性卒中患者，随访时间为 1 年。
改良的 Essen 卒中风险评分是根据年龄、高血压、糖尿病、既往心肌梗死、除心肌梗死和心房颤动以外的其他心血管疾病、外周动脉疾病、吸烟以及既往卒中和短暂性脑缺血发作等因素的腰围、病因学的卒中亚型和性别评分计算得出。多变量逻辑回归模型确定了预测因素（每项赋值为 1 分或 2 分），并提供了改良 Essen 卒中风险评分的 c 统计量。我们考虑了两种结局，即复发性缺血性卒中和心血管事件（定义为致命或非致命性卒中、心肌梗死、非致命性不稳定型心绞痛和心脏死亡的联合结局）。
在 1 年内，121 例患者（3.7%）发生复发性缺血性卒中和 133 例患者（4.0%）发生心血管事件。c 统计量（用于区分）在复发性卒中为 0.632，在心血管事件为 0.640。评分≥6 分的患者被归类为高危，否则为低危。Kaplan-Meier 分析显示，改良风险评分在男性和女性中均比 Essen 卒中风险评分具有更好的预测能力。
改良的 Essen 卒中风险评分提高了 Essen 卒中风险评分预测复发性心血管事件的能力。具有高改良 Essen 卒中风险评分的患者应成为强化二级预防策略的候选者。
