TAGE 评分用于预测急性缺血性脑卒中血管内治疗成功后症状性颅内出血
TAGE Score for Symptomatic Intracranial Hemorrhage Prediction After Successful Endovascular Treatment in Acute Ischemic Stroke.
机构信息
Department of Neuroradiology (P.J., B.K., J.B., L.L., C.O., O.N., W.B.H.), Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.
Neurology (G.T.), Université de Paris, INSERM U1266, Institute of Psychiatry and Neuroscience of Paris, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.
出版信息
Stroke. 2022 Sep;53(9):2809-2817. doi: 10.1161/STROKEAHA.121.038088. Epub 2022 Jun 14.
BACKGROUND
Determine if early venous filling (EVF) after complete successful recanalization with mechanical thrombectomy in acute ischemic stroke is an independent predictor of symptomatic intracranial hemorrhage (sICH) and integrate EVF into a risk score for sICH prediction.
METHODS
Consecutive patients with anterior acute ischemic stroke treated by mechanical thrombectomy issued from patients enrolled in the THRACE trial (Thrombectomie des Artères Cérébrales) and from 2 prospective registries were included and divided into a derivation (Center I; n=402) and validation cohorts (THRACE and center 2; n=507). EVF was evaluated by 2 blinded readers. sICH was defined according to the modified European cooperative acute stroke study II. Clinical and radiological data were analyzed in the derivation cohort (C1) to identify independent predictors of sICH and construct a predictive score test on the validation cohort (THRACE + C2).
RESULTS
Symptomatic ICH rate was similar between the two cohorts (9.9% and 8.9% respectively, =0.9). Time from onset-to-successful recanalization >270 minutes (odds ratio [OR], 7.8 [95% CI, 2.5-24]), Alberta Stroke Program Early CT Score (≤5 [OR, 2.49 (95% CI, 1.8-8.1) or 6-7 [OR, 1.15 (95% CI, 1.03-4.46)]), glucose blood level >7 mmol/L (OR, 2.92 [95% CI, 1.26-6.7]), and EVF presence (OR, 11.9 [95% CI, 3.8-37.5]) were independent predictors of sICH and constituted the Time-Alberta Stroke Program Early CT-Glycemia-EVF score. Time-Alberta Stroke Program Early CT-Glycemia-EVF score was associated with an increased risk of sICH in the derivation cohort (OR increase per unit, 1.99 [95% CI, 1.53-2.59]; <0.001) with area under the curve, 0.832 [95% CI, 0.767-0.898]. The score had good performance in the validation cohort (area under the curve, 0.801 [95% CI, 0.69-0.91]).
CONCLUSIONS
Time-Alberta Stroke Program Early CT-Glycemia-EVF score is a simple tool with readily available clinical variables with good performances for sICH prediction after mechanical thrombectomy.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT01062698.
背景
确定急性缺血性卒中机械取栓完全再通后早期静脉充盈（EVF）是否为症状性颅内出血（sICH）的独立预测因素，并将 EVF 纳入 sICH 预测的风险评分。
方法
连续纳入接受机械取栓治疗的急性前循环缺血性卒中患者，分别来自 THRACE 试验（Thrombectomie des Artères Cérébrales）和 2 个前瞻性登记处的患者，并将其分为推导队列（中心 I；n=402）和验证队列（THRACE 和中心 2；n=507）。由 2 名盲法读者评估 EVF。sICH 根据改良的欧洲合作急性卒中研究 II 定义。在推导队列（C1）中分析临床和影像学数据，以确定 sICH 的独立预测因素，并在验证队列（THRACE+C2）上构建预测评分检验。
结果
两组的症状性 ICH 发生率相似（分别为 9.9%和 8.9%，=0.9）。发病至再通时间>270 分钟（比值比[OR]，7.8[95%CI，2.5-24]）、急性卒中计划早期 CT 评分（≤5[OR，2.49（95%CI，1.8-8.1）或 6-7[OR，1.15（95%CI，1.03-4.46）]）、血糖水平>7mmol/L（OR，2.92[95%CI，1.26-6.7]）和 EVF 存在（OR，11.9[95%CI，3.8-37.5]）是 sICH 的独立预测因素，并构成时间-急性卒中计划早期 CT-血糖-EVF 评分。时间-急性卒中计划早期 CT-血糖-EVF 评分与推导队列中 sICH 风险增加相关（单位 OR 增加，1.99[95%CI，1.53-2.59]；<0.001），曲线下面积为 0.832[95%CI，0.767-0.898]。该评分在验证队列中表现良好（曲线下面积，0.801[95%CI，0.69-0.91]）。
结论
时间-急性卒中计划早期 CT-血糖-EVF 评分是一种简单的工具，具有良好的性能，可用于预测机械取栓后 sICH，其预测因子均为临床中易于获得的变量。
登记
网址：https://www.
临床试验
gov；唯一标识符：NCT01062698。
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