Key result
ESRS and SPI-II scores show modest predictive accuracy for 5-year stroke recurrence and vascular events.
Why the study?
Risk prediction scores stratify patients for stroke recurrence and guide preventive treatment, but validation of ESRS and SPI-II for predicting long-term outcomes in Chinese patients with acute ischemic stroke was needed.
Do the ESRS and SPI-II scores accurately predict 5-year stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke?
Cohort (n=876)
Do the ESRS and SPI-II scores accurately predict 5-year stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke?
The ESRS and SPI-II scores have only modest predictive power for 5-year stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke, highlighting the need for a population-specific model.
Existing scores warrant cautious use for 5-year prognostication in Chinese patients; leaves open development of population-specific models.
Background: The risk prediction score for stroke recurrence is an important tool for stratifying patients based on the risk of cerebrovascular events and selecting potential preventive treatments. Objective: The study aimed to validate the Essen Stroke Risk Score (ESRS) and Stroke Prognosis Instrument II (SPI-II) for predicting long-term risk of stroke recurrence and combined vascular events in Chinese patients with acute ischemic stroke (AIS). Methods: A total of 876 consecutive patients with non-atrial fibrillation AIS were recruited. The Kaplan-Meier (KM) method was used to estimate the cumulative incidence of stroke recurrence and combined vascular events in different subgroups stratified by the ESRS and SPI-II scores. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the predictive value of the two scores for stroke recurrence and combined vascular events. Results: The KM estimate for 5-year cumulative incidence of stroke recurrence and combined vascular events was 28.7% (95% confidence interval [CI], 25.4-32.0) and 35.6% (95% CI, 32.3-38.9), respectively, in Chinese AIS patients. The risk of stroke recurrence and combined vascular events were increased significantly with increasing ESRS and SPI-II scores. The ESRS and SPI-II scores had similar predictive accuracy for stroke recurrence (AUC 0.57 [95% CI 0.52-0.64] vs 0.59 [95% CI 0.55-0.64]) and combined vascular events (AUC 0.59 [95% CI 0.55-0.63] vs 0.62 [95% CI 0.58-0.66]) at 5 years. Conclusion: In Chinese patients with AIS, both ESRS and SPI-II scores were able to stratify the risk of 5-year recurrent stroke and combined vascular events. The predictive power of the two scores were modest and a prediction model suitable for Chinese IS populations is needed.
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Zhao et al. (2023) conducted a cohort in Acute ischemic stroke (AIS) without atrial fibrillation (n=876). Essen Stroke Risk Score (ESRS) vs. Stroke Prognosis Instrument II (SPI-II) was evaluated on Stroke recurrence at 5 years (AUC 0.57 (ESRS) vs 0.59 (SPI-II), 95% CI 0.52-0.64 vs 0.55-0.64). The ESRS and SPI-II scores demonstrated modest predictive accuracy for 5-year stroke recurrence (AUC 0.57 vs 0.59) and combined vascular events in Chinese patients with acute ischemic stroke.
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