BACKGROUND: The Totaled Health Risks in Vascular Events (THRIVE) score strongly predicts clinical outcome, mortality, and risk of thrombolytic haemorrhage in ischemic stroke patients, and performs similarly well in patients receiving intravenous tissue plasminogen activator, endovascular stroke treatment, or no acute treatment. It is not known if the THRIVE score predicts outcomes with the Solitaire endovascular stroke treatment device. AIMS: To validate the relationship between the THRIVE score and outcomes after treatment with the Solitaire endovascular stroke treatment device. METHODS: The study conducted a retrospective analysis of the prospective SWIFT and STAR trials to examine the relationship between THRIVE and outcomes after treatment with the Solitaire device. We examined the relationship between THRIVE and clinical outcomes (good outcome or death at 90 days) among patients in SWIFT and STAR. Receiver-operator characteristics curve analysis was used to compare THRIVE score performance with other stroke prediction scores. Multivariable modeling was used to confirm the independence of the THRIVE score from procedure-specific predictors (successful recanalization or device used) and other predictors of functional outcome. RESULTS: The THRIVE score strongly predicts good outcome and death among patients treated with the Solitaire device in SWIFT and STAR (Mantel-Haenszel chi-square test for trend P < 0·001 for good outcome, P = 0·01 for death). In receiver-operator characteristics (ROC) curve comparisons, totaled health risks in vascular events score is superior to Stroke Prognostication using Age and NIH Stroke Scale score-100 (P < 0·001) and performed similarly to Houston Intra-Arterial Therapy score (HIAT) (P = 0·98) and HIAT-2 (P = 0·54). In multivariable models, THRIVE's prediction of good outcome is not altered after controlling for recanalization or after controlling for device used. The THRIVE score remains a strong independent predictor after controlling for the above predictors together with time to procedure, rate of symptomatic haemorrhage, and use of general anesthesia. Of note, use of general anesthesia was not an independent predictor of outcome in SWIFT + STAR after controlling for totaled health risks in vascular events and other factors. CONCLUSIONS: The THRIVE score strongly predicts clinical outcome and mortality in patients treated with the Solitaire device in the SWIFT and STAR trials. The lack of interaction between THRIVE and procedure-specific elements such as vessel recanalization or device choice makes the THRIVE score a reasonable candidate for use as a patient selection criterion in stroke clinical trials.
RCT Entities:
<span class="abstract_title">BACKGROUND: The Totaled Health Risks in Vascular Events (THRIVE) score strongly predicts clinical outcome, mortality, and risk of <span class="Disease">thrombolytic haemorrhage in <span class="Disease">ischemic stroke <span class="Species">patients, and performs similarly well in <span class="Species">patients receiving intravenous tissue plasminogen activator, <span class="Disease">endovascular stroke treatment, or no acute treatment. It is not known if the THRIVE score predicts outcomes with the Solitaire <span class="Disease">endovascular stroke treatment device. AIMS: To validate the relationship between the THRIVE score and outcomes after treatment with the Solitaire <span class="Disease">endovascular stroke treatment device. <span class="abstract_title">METHODS: The study conducted a retrospective analysis of the prospective SWIFT and <span class="Gene">STAR trials to examine the relationship between THRIVE and outcomes after treatment with the Solitaire device. We examined the relationship between THRIVE and clinical outcomes (good outcome or <span class="Disease">death at 90 days) among <span class="Species">patients in SWIFT and <span class="Gene">STAR. Receiver-operator characteristics curve analysis was used to compare THRIVE score performance with other <span class="Disease">stroke prediction scores. Multivariable modeling was used to confirm the independence of the THRIVE score from procedure-specific predictors (successful recanalization or device used) and other predictors of functional outcome. <span class="abstract_title">RESULTS: The THRIVE score strongly predicts good outcome and <span class="Disease">death among <span class="Species">patients treated with the Solitaire device in SWIFT and <span class="Gene">STAR (Mantel-Haenszel chi-square test for trend P < 0·001 for good outcome, P = 0·01 for <span class="Disease">death). In receiver-operator characteristics (ROC) curve comparisons, totaled health risks in vascular events score is superior to <span class="Disease">Stroke Prognostication using Age and <span class="Disease">NIH Stroke Scale score-100 (P < 0·001) and performed similarly to Houston Intra-Arterial Therapy score (HIAT) (P = 0·98) and <span class="Disease">HIAT-2 (P = 0·54). In multivariable models, THRIVE's prediction of good outcome is not altered after controlling for recanalization or after controlling for device used. The THRIVE score remains a strong independent predictor after controlling for the above predictors together with time to procedure, rate of symptomatic <span class="Disease">haemorrhage, and use of general anesthesia. Of note, use of general anesthesia was not an independent predictor of outcome in SWIFT + <span class="Gene">STAR after controlling for totaled health risks in vascular events and other factors. <span class="abstract_title">CONCLUSIONS: The THRIVE score strongly predicts clinical outcome and mortality in <span class="Species">patients treated with the Solitaire device in the SWIFT and <span class="Gene">STAR trials. The lack of interaction between THRIVE and procedure-specific elements such as vessel recanalization or device choice makes the THRIVE score a reasonable candidate for use as a <span class="Species">patient selection criterion in <span class="Disease">stroke clinical trials.
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Authors: Amrou Sarraj; Karen Albright; Andrew D Barreto; Amelia K Boehme; Clark W Sitton; Jeanie Choi; Steven L Lutzker; Chung-Huan J Sun; Wafi Bibars; Claude B Nguyen; Osman Mir; Farhaan Vahidy; Tzu-Ching Wu; George A Lopez; Nicole R Gonzales; Randall Edgell; Sheryl Martin-Schild; Hen Hallevi; Peng Roc Chen; Mark Dannenbaum; Jeffrey L Saver; David S Liebeskind; Raul G Nogueira; Rishi Gupta; James C Grotta; Sean I Savitz Journal: Stroke Date: 2013-08-08 Impact factor: 7.914
Authors: R Bourcier; S Volpi; B Guyomarch; B Daumas-Duport; A Lintia-Gaultier; C Papagiannaki; J M Serfaty; H Desal Journal: AJNR Am J Neuroradiol Date: 2015-08-27 Impact factor: 3.825