Yang Dong, Yuan Kang, Zhu Wusheng, Lin Min, Liu Xinfeng
Department of Neurology Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University Nanjing China.
Department of Neurology The Second Affiliated Hospital of Fujian Traditional Chinese Medical University Fuzhou Fujian China.
J Am Heart Assoc. 2025 Apr 15;14(8):e036329. doi: 10.1161/JAHA.124.036329. Epub 2025 Apr 10.
We aimed to develop and validate a prognostic score to predict outcomes after endovascular treatment in acute ischemic stroke.
The prognostic score was developed based on the ACTUAL (Endovascular Treatment for Acute Anterior Circulation Ischemic Stroke) registry. The validation cohort was derived from the Captor trial. Independent predictors of poor outcome after endovascular treatment were obtained from the least absolute shrinkage and selection operator regression and multivariable logistic regression. Corresponding regression coefficients were used to generate point scoring system. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. The predictive properties of the developed prognostic score were validated and the discriminative power was compared with other validated tools.
A 17-point Age, Collateral Status, Blood glucose, Alberta Stroke Program Early Computed Tomography Score, and National Institutes of Health Stroke Scale score scale was developed from the set of independent predictors, including age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography Score on initial computed tomography scan, blood glucose, and collateral status. The scale showed good discrimination in the derivation cohort (area under the receiver operating characteristic curve, 0.79 [95% CI, 0.75-0.82]) and validation cohorts (area under the receiver operating characteristic curve, 0.77 [95% CI, 0.70-0.84]). The scale was well calibrated (Hosmer-Lemeshow test) in the derivation cohort (=0.57) and validation cohort (=0.75).
The Age, Collateral Status, Blood glucose, Alberta Stroke Program Early Computed Tomography score, and National Institutes of Health Stroke Scale score scale is a valid tool for predicting outcomes and may be useful for endovascular stroke treatment in anterior circulation large vessel occlusions.
我们旨在开发并验证一种预后评分系统，以预测急性缺血性卒中血管内治疗后的结局。
该预后评分系统基于ACTUAL（急性前循环缺血性卒中血管内治疗）注册研究开发。验证队列来自Captor试验。通过最小绝对收缩和选择算子回归及多变量逻辑回归获得血管内治疗后不良结局的独立预测因素。使用相应的回归系数生成评分系统。采用受试者工作特征曲线下面积和Hosmer-Lemeshow拟合优度检验评估模型的区分度和校准度。对所开发的预后评分系统的预测性能进行验证，并将其区分能力与其他已验证的工具进行比较。
从包括年龄、入院时美国国立卫生研究院卒中量表评分、初次计算机断层扫描时的阿尔伯塔卒中项目早期计算机断层扫描评分、血糖和侧支循环状态等一组独立预测因素中开发出了一种包含年龄、侧支循环状态、血糖、阿尔伯塔卒中项目早期计算机断层扫描评分和美国国立卫生研究院卒中量表评分的17分评分系统。该评分系统在推导队列（受试者工作特征曲线下面积，0.79 [95% CI，0.75 - 0.82]）和验证队列（受试者工作特征曲线下面积，0.77 [95% CI，0.70 - 0.84]）中显示出良好的区分度。该评分系统在推导队列（ Hosmer-Lemeshow检验，=0.57）和验证队列（=0.75）中校准良好。
年龄、侧支循环状态、血糖、阿尔伯塔卒中项目早期计算机断层扫描评分和美国国立卫生研究院卒中量表评分系统是预测结局的有效工具，可能有助于前循环大血管闭塞性卒中的血管内治疗。
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