학술논문
Prediction of Outcome and Endovascular Treatment Benefit
Document Type
article
Author
Venema, Esmee; Roozenbeek, Bob; Mulder, Maxim JHL; Brown, Scott; Majoie, Charles BLM; Steyerberg, Ewout W; Demchuk, Andrew M; Muir, Keith W; Dávalos, Antoni; Mitchell, Peter J; Bracard, Serge; Berkhemer, Olvert A; Lycklama à Nijeholt, Geert J; van Oostenbrugge, Robert J; Roos, Yvo BWEM; van Zwam, Wim H; van der Lugt, Aad; Hill, Michael D; White, Philip; Campbell, Bruce CV; Guillemin, Francis; Saver, Jeffrey L; Jovin, Tudor G; Goyal, Mayank; Dippel, Diederik WJ; Lingsma, Hester F; der Lugt, Aad van; Boiten, Jelis; Vos, Jan Albert; Jansen, Ivo GH; Goldhoorn, Robert-Jan B; Compagne, Kars CJ; Kappelhof, Manon; Brouwer, Josje; den Hartog, Sanne J; Hinsenveld, Wouter H; van Es, Adriaan CGM; Emmer, Bart J; Coutinho, Jonathan M; Schonewille, Wouter J; Wermer, Marieke JH; van Walderveen, Marianne AA; Staals, Julie; Hofmeijer, Jeannette; Martens, Jasper M; de Bruijn, Sebastiaan F; van Dijk, Lukas C; van der Worp, H Bart; Lo, Rob H; van Dijk, Ewoud J; Boogaarts, Hieronymus D; Vries, J de; de Kort, Paul LM; van Tuijl, Julia; Peluso, Jo P; Fransen, Puck; van den Berg, Jan SP; van Hasselt, Boudewijn AAM; Aerden, Leo AM; Dallinga, René J; Uyttenboogaart, Maarten; Eschgi, Omid; Bokkers, Reinoud PH; Schreuder, Tobien HCML; Heijboer, Roel JJ; Keizer, Koos; Yo, Lonneke SF; den Hertog, Heleen M; Bulut, Tomas; Brouwers, Paul JAM; Sprengers, Marieke ES; Jenniskens, Sjoerd FM; van den Berg, René; Yoo, Albert J; Beenen, Ludo FM; Postma, Alida A; Roosendaal, Stefan D; van der Kallen, Bas FW; van den Wijngaard, Ido R; Bot, Joost; van Doormaal, Pieter-Jan; Meijer, Anton; Ghariq, Elyas; van Proosdij, Marc P; Krietemeijer, G Menno; Lo, Rob; Gerrits, Dick; Dinkelaar, Wouter; Appelman, Auke PA
Source
Stroke. 52(9)
Subject
Language
Abstract
Background and purposeBenefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice.MethodsWe used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic.ResultsWe included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (