Cappellari Manuel, Mangiafico Salvatore, Saia Valentina, Pracucci Giovanni, Nappini Sergio, Nencini Patrizia, Konda Daniel, Sallustio Fabrizio, Vallone Stefano, Zini Andrea, Bracco Sandra, Tassi Rossana, Bergui Mauro, Cerrato Paolo, Pitrone Antonio, Grillo Francesco, Saletti Andrea, De Vito Alessandro, Gasparotti Roberto, Magoni Mauro, Puglielli Edoardo, Casalena Alfonsina, Causin Francesco, Baracchini Claudio, Castellan Lucio, Malfatto Laura, Menozzi Roberto, Scoditti Umberto, Comelli Chiara, Duc Enrica, Comai Alessio, Franchini Enrica, Cosottini Mirco, Mancuso Michelangelo, Peschillo Simone, De Michele Manuela, Giorgianni Andrea, Luisa Delodovici Maria, Lafe Elvis, Denaro Maria F, Burdi Nicola, Internò Saverio, Cavasin Nicola, Critelli Adriana, Chiumarulo Luigi, Petruzzellis Marco, Doddi Marco, Carolei Antonio, Auteri William, Petrone Alfredo, Padolecchia Riccardo, Tassinari Tiziana, Pavia Marco, Invernizzi Paolo, Turcato Gianni, Forlivesi Stefano, Francesca Maria Ciceri Elisa, Bonetti Bruno, Inzitari Domenico, Toni Danilo
Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Ospedale Careggi-University Hospital, Firenze, Italy.
Int J Stroke. 2020 Jun;15(4):412-420. doi: 10.1177/1747493019837756. Epub 2019 Mar 25.
The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.
We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.
We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).
A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( = 1219) and test ( = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set.
The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.
目前用于预测大血管闭塞（LVO）性卒中血管内血栓切除术后功能结局的模型，其适用性受到中等预测性能的影响。
我们旨在开发并验证一种列线图，纳入治疗前和治疗后因素，以预测接受桥接治疗或在卒中发作<6小时内行直接血栓切除术的前循环和后循环LVO患者出现不良结局的概率。
我们对意大利血管内注册研究（IER）前瞻性收集的患者数据进行了一项队列研究。不良结局定义为3个月改良Rankin量表（mRS）评分3 - 6分。六位预测因素，包括美国国立卫生研究院卒中量表（NIHSS）评分、年龄、卒中前mRS评分、桥接治疗或直接血栓切除术、根据脑缺血溶栓（TICI）分级系统的再通等级以及从发病到手术结束的时间，由三位卒中专家预先确定。为生成IER - START列线图，将预先确定的预测因素纳入逻辑回归模型。通过使用受试者操作特征曲线下面积（AUC - ROC）评估模型的判别性能。
共有1802例具有完整数据以生成IER - START列线图的患者被随机分为训练集（n = 1219）和测试集（n = 583）。IER - START列线图在训练集中的AUC - ROC为0.838（95%置信区间[CI]：0.816 - 0.869），在测试集中为0.820（95% CI：0.786 - 0.854）。
IER - START列线图是首个在目前接受血栓切除术的最大规模卒中患者群体中开发并验证的预后模型，它能可靠地计算出3个月不良结局的概率。
