학술논문
Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT.
Document Type
Academic Journal
Author
Flint AC; Division of Research and Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA.; Chan SL; Division of Research and Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA.; Edwards NJ; Division of Research and Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA.; Rao VA; Division of Research and Department of Neuroscience, Kaiser Permanente, Redwood City, CA, USA.; Klingman JG; Department of Neurology, Kaiser Permanente, Walnut Creek, CA, USA.; Nguyen-Huynh MN; Department of Neurology, Kaiser Permanente, Walnut Creek, CA, USA.; Yan B; Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.; Mitchell PJ; Department of Radiology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, VIC, Australia.; Davis SM; Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.; Campbell BC; Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.; Dippel DW; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.; Roos YB; Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands.; van Zwam WH; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.; Saver JL; Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, Los Angeles, CA, USA.; Kidwell CS; Department of Neurology, The University of Arizona, Tucson, AZ, USA.; Hill MD; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Goyal M; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Demchuk AM; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Bracard S; Department of Neuroradiology, University of Lorraine, Nancy, France.; Bendszus M; Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.; Donnan GA; Melbourne Brain Centre at Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
Source
Publisher: SAGE Publications Country of Publication: United States NLM ID: 101274068 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1747-4949 (Electronic) Linking ISSN: 17474930 NLM ISO Abbreviation: Int J Stroke Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: The THRIVE score and the THRIVE-c calculation are validated ischemic stroke outcome prediction tools based on patient variables that are readily available at initial presentation. Randomized controlled trials (RCTs) have demonstrated the benefit of endovascular treatment (EVT) for many patients with large vessel occlusion (LVO), and pooled data from these trials allow for adaptation of the THRIVE-c calculation for use in shared clinical decision making regarding EVT.
Methods: To extend THRIVE-c for use in the context of EVT, we extracted data from the Virtual International Stroke Trials Archive (VISTA) from 7 RCTs of EVT. Models were built in a randomly selected development cohort using logistic regression that included the predictors from THRIVE-c: age, NIH Stroke Scale (NIHSS) score, presence of hypertension, diabetes mellitus, and/or atrial fibrillation, as well as randomization to EVT and, where available, the Alberta Stroke Program Early CT Score (ASPECTS).
Results: Good outcome was achieved in 366/787 (46.5%) of subjects randomized to EVT and in 236/795 (29.7%) of subjects randomized to control (P < 0.001), and the improvement in outcome with EVT was seen across age, NIHSS, and THRIVE-c good outcome prediction. Models to predict outcome using THRIVE elements (age, NIHSS, and comorbidities) together with EVT, with or without ASPECTS, had similar performance by ROC analysis in the development and validation cohorts (THRIVE-EVT ROC area under the curve (AUC) = 0.716 in development, 0.727 in validation, P = 0.30; THRIVE-EVT + ASPECTS ROC AUC = 0.718 in development, 0.735 in validation, P = 0.12).
Conclusion: THRIVE-EVT may be used alongside the original THRIVE-c calculation to improve outcome probability estimation for patients with acute ischemic stroke, including patients with or without LVO, and to model the potential improvement in outcomes with EVT for an individual patient based on variables that are available at initial presentation. Online calculators for THRIVE-c estimation are available at www.thrivescore.org and www.mdcalc.com/thrive-score-for-stroke-outcome.
Methods: To extend THRIVE-c for use in the context of EVT, we extracted data from the Virtual International Stroke Trials Archive (VISTA) from 7 RCTs of EVT. Models were built in a randomly selected development cohort using logistic regression that included the predictors from THRIVE-c: age, NIH Stroke Scale (NIHSS) score, presence of hypertension, diabetes mellitus, and/or atrial fibrillation, as well as randomization to EVT and, where available, the Alberta Stroke Program Early CT Score (ASPECTS).
Results: Good outcome was achieved in 366/787 (46.5%) of subjects randomized to EVT and in 236/795 (29.7%) of subjects randomized to control (P < 0.001), and the improvement in outcome with EVT was seen across age, NIHSS, and THRIVE-c good outcome prediction. Models to predict outcome using THRIVE elements (age, NIHSS, and comorbidities) together with EVT, with or without ASPECTS, had similar performance by ROC analysis in the development and validation cohorts (THRIVE-EVT ROC area under the curve (AUC) = 0.716 in development, 0.727 in validation, P = 0.30; THRIVE-EVT + ASPECTS ROC AUC = 0.718 in development, 0.735 in validation, P = 0.12).
Conclusion: THRIVE-EVT may be used alongside the original THRIVE-c calculation to improve outcome probability estimation for patients with acute ischemic stroke, including patients with or without LVO, and to model the potential improvement in outcomes with EVT for an individual patient based on variables that are available at initial presentation. Online calculators for THRIVE-c estimation are available at www.thrivescore.org and www.mdcalc.com/thrive-score-for-stroke-outcome.