匹兹堡卒中介入治疗后评分预测前循环大血管闭塞血管内治疗的结局。
Pittsburgh outcomes after stroke thrombectomy score predicts outcomes after endovascular therapy for anterior circulation large vessel occlusions.
机构信息
From the Department of Neurology, University of Pittsburgh Medical Center, PA (S.R., A.A., C.S., A.J., T.G.J.); Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (C.-H.S., R.N., M.F.); Wellstar Neurosurgery, Atlanta, GA (R.G.); and Stanford Stroke Center, Stanford University Medical Center, CA (J.T.P.L., M.M., M.L., G.A.).
出版信息
Stroke. 2014 Aug;45(8):2298-304. doi: 10.1161/STROKEAHA.114.005595. Epub 2014 Jul 8.
BACKGROUND AND PURPOSE
Prognostication tools that predict good outcome in patients with anterior circulation large vessel occlusions after endovascular therapy are lacking. We aim to develop a tool that incorporates clinical and imaging data to predict outcomes after endovascular therapy.
METHODS
In a derivation cohort of anterior circulation large vessel occlusion stroke patients treated with endovascular therapy within 8 hours from time last seen well (n=247), we performed logistic regression to identify independent predictors of good outcome (90-day modified Rankin Scale, 0-2). Factors were weighted based on β-coefficients to derive the Pittsburgh Outcomes After Stroke Thrombectomy (POST) score. POST was validated in an institutional endovascular database (University of Pittsburgh Medical Center, n=393) and the Diffusion-Weighted Imaging Evaluation for Understanding Stroke Evolution Study-2 (DEFUSE-2) data set (n=105), as well as in patients treated beyond 8 hours (n=194) and in octogenarians (n=111).
RESULTS
In the derivation cohort, independent predictors (P<0.1) of good outcome included 24- to 72-hour final infarct volume (in cm(3), P<0.001), age (years, P<0.001), and parenchymal hematoma types 1 and 2 (H, P=0.01). POST was calculated as age+0.5×final infarct volume+15×H. Patients with POST score <60 had a 91% chance of good outcome compared with 4% with POST score ≥120. POST accurately predicted good outcomes in the derivation (area under the curve [AUC]=0.85) and validation cohorts (University of Pittsburgh Medical Center, AUC=0.81; DEFUSE-2, AUC=0.86), as well as in patients treated beyond 8 hours (AUC, 0.85) and octogenarians (AUC=0.76). POST had better predictive accuracy for good and poor outcome than the ischemic stroke predictive risk score (iSCORE).
CONCLUSIONS
POST score is a validated predictor of outcome in patients with anterior circulation large vessel occlusions after endovascular therapy.
背景与目的
缺乏预测血管内治疗后前循环大血管闭塞患者预后良好的工具。我们旨在开发一种结合临床和影像学数据来预测血管内治疗后结局的工具。
方法
在前循环大血管闭塞性卒中患者的队列中，这些患者在最后一次看到正常后 8 小时内接受血管内治疗（n=247），我们进行逻辑回归以确定良好预后的独立预测因素（90 天改良 Rankin 量表，0-2）。根据β系数为这些因素加权，得出匹兹堡卒中血管内治疗后结局（POST）评分。在机构血管内数据库（匹兹堡大学医学中心，n=393）和弥散加权成像评估理解卒中演变研究-2（DEFUSE-2）数据集（n=105）中对 POST 进行验证，以及治疗时间超过 8 小时（n=194）和 80 岁以上的患者（n=111）中。
结果
在推导队列中，良好预后的独立预测因素（P<0.1）包括 24-72 小时的最终梗死体积（cm3，P<0.001）、年龄（岁，P<0.001）和实质血肿类型 1 和 2（H，P=0.01）。POST 计算为年龄+0.5×最终梗死体积+15×H。POST 评分<60 的患者有 91%的良好预后机会，而 POST 评分≥120 的患者有 4%的良好预后机会。POST 在推导队列（曲线下面积[AUC]=0.85）和验证队列（匹兹堡大学医学中心，AUC=0.81；DEFUSE-2，AUC=0.86）以及治疗时间超过 8 小时的患者（AUC，0.85）和 80 岁以上的患者（AUC=0.76）中准确预测了良好结局。POST 对良好和不良结局的预测准确性优于缺血性卒中预测风险评分（iSCORE）。
结论
POST 评分是血管内治疗后前循环大血管闭塞患者预后的有效预测因子。
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