Comparison of Risk Scores for the Prediction of the Overall Cardiovascular Risk in Patients with Ischemic Stroke: The Athens Stroke Registry

摘要

Background: Stratification of overall vascular risk in patients with ischemic stroke is important as it may guide management decisions. Currently available schemes have only modest prognostic accuracy. The TRA2 degrees P score aids in vascular risk stratification in patients with previous myocardial infarction (MI). Aim: We investigated whether the prognostic performance of TRA2 degrees P can be extended in patients with ischemic stroke and whether it can improve the risk stratification made by CHA(2)DS(2)-VASc and Essen-Stroke-Risk-Score (ESRS). Methods: We analyzed the Athens Stroke Registry using Kaplan-Meier survival and Cox-regression analyses to assess if TRA2 degrees P (in different categorizations) predicts the composite endpoint of stroke recurrence, MI or cardiovascular death. We compared its incremental predictive value over CHA(2)DS(2)-VASc and ESRS and calculated continuous net reclassification indices (cNRI). Results: In 2833 patients (followed for 9278 patient-years) and 776 events, there was decreased survival probability for TRA2 degrees P-based high-risk patients compared to low-risk (log-rank-test P < .001), but the discriminatory power for the occurrence of the composite endpoint was only modest (Harrell's-C:.566, 95% CI:.545-.587). Combined with ESRS, TRA2 degrees P conferred incremental discrimination (Harrell's-C:.544, 95% CI:.513-.574 versus .574, 95% CI:.543-.605 respectively, P = .049) and reclassification value (cNRI = 9.8%, P = .02). Combined with CHA 2 DS2-VASc, TRA2 degrees P did not improve discrimination (Harell's-C:.578, 95% CI: .547-.608 versus .585, 95% CI:.554-.616, P = .738). Conclusion: The currently available prognostic scores have generally low performance to predict the overall cardiovascular risk in ischemic stroke patients. Further research is needed to improve vascular risk stratification in ischemic stroke patients.