THRIVE 评分可预测第三代血管内卒中治疗装置在 TREVO-2 试验中的结局。
THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial.
机构信息
From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F.); Department of Clinical Research, Prospect Analytical, San Jose, CA (B.X.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G., R.G.N.); Department of Neurology, Oregon Health and Science University, Portland, OR (H.L.L.); Department of Neurology, UPMC Stroke Center, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA (G.W.A.); Department of Neurology, UCLA Stroke Center, University of California, Los Angeles, CA (D.S.L.); Department of Neurology, University of Southern California, Los Angeles, CA (N.S.); and Department of Neurology, University of California, San Francisco, CA (W.S.S.).
出版信息
Stroke. 2013 Dec;44(12):3370-5. doi: 10.1161/STROKEAHA.113.002796. Epub 2013 Sep 26.
BACKGROUND AND PURPOSE
Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device).
METHODS
We used data from the TREVO-2 trial to validate the Totaled Health Risks in Vascular Events (THRIVE) score in patients receiving treatment with a third-generation endovascular stroke treatment device and to compare THRIVE to other predictive scores. We used logistic regression to model outcomes and compared score performance with receiver operating characteristic curve analysis.
RESULTS
In the TREVO-2 trial, the THRIVE score strongly predicts clinical outcome and mortality. The relationship between THRIVE score and outcome is not influenced by either success of recanalization or the type of device used (Trevo versus Merci). The superiority of the Trevo device to the Merci device is evident particularly among patients with a low-to-moderate THRIVE score (0-5; 53.8% good outcome with Trevo versus 27.5% good outcome with Merci). In receiver operating characteristic curve analysis, the THRIVE score was comparable or superior to several other outcome prediction scores (HIAT, HIAT-2, SPAN-100, and iScore).
CONCLUSIONS
The THRIVE score strongly predicts clinical outcome and mortality in the TREVO-2 trial. Taken together with THRIVE validation data from patients receiving intravenous tissue-type plasminogen activator or no acute treatment, the THRIVE score has broad predictive power in patients with acute ischemic stroke, which is likely because THRIVE reflects a set of strong nonmodifiable predictors of stroke outcome. A free Web calculator for the THRIVE score is available at http://www.thrivescore.org.
背景与目的
已有多种预后评分在采用前几代血管内卒中治疗设备进行急性卒中治疗的患者中进行了验证。TREVO-2 试验是一项比较新型血管内卒中治疗设备（Trevo 装置）与前一代血管内卒中治疗设备（Merci 装置）的随机对照试验。
方法
我们使用 TREVO-2 试验的数据来验证第三代血管内卒中治疗设备治疗患者的总血管事件健康风险（THRIVE）评分，并将 THRIVE 与其他预测评分进行比较。我们使用逻辑回归对结局进行建模，并通过受试者工作特征曲线分析比较评分性能。
结果
在 TREVO-2 试验中，THRIVE 评分强烈预测临床结局和死亡率。THRIVE 评分与结局之间的关系不受再通成功与否或所使用的装置类型（Trevo 与 Merci）的影响。Trevo 装置优于 Merci 装置，这在 THRIVE 评分较低至中等（0-5 分；Trevo 组 53.8%患者获得良好结局，而 Merci 组仅 27.5%）的患者中尤其明显。在受试者工作特征曲线分析中，THRIVE 评分与其他几种结局预测评分（HIAT、HIAT-2、SPAN-100 和 iScore）相当或更优。
结论
THRIVE 评分在 TREVO-2 试验中强烈预测临床结局和死亡率。与接受静脉内组织型纤溶酶原激活剂或无急性治疗的患者的 THRIVE 验证数据相结合，THRIVE 评分在急性缺血性卒中患者中具有广泛的预测能力，这可能是因为 THRIVE 反映了一组卒中结局的强不可变预测因素。THRIVE 评分的免费网络计算器可在 http://www.thrivescore.org 获得。
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