Shoichiro Sato1, Toshiyuki Uehara2, Tomoyuki Ohara2, Rieko Suzuki2, Kazunori Toyoda2, Kazuo Minematsu2. 1. From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. sato.shoichiro.hp@ncvc.go.jp. 2. From the Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Abstract
OBJECTIVES: The purpose of this study was to elucidate the factors that correlate with unfavorable outcomes and to develop a simple validated model for assessing risk of unfavorable outcomes in patients with minor ischemic stroke. METHODS: The derivation cohort included 1,313 patients hospitalized within 72 hours after onset with an initial NIH Stroke Scale score of 0 to 3 enrolled in a prospective, multicenter, observational study. Unfavorable outcome was defined as dependency (modified Rankin Scale score of 3-5) or death at 90 days. The predictive values of factors related to unfavorable outcome were evaluated. External validation was performed in 879 patients from a single-center stroke registry. RESULTS: In the derivation cohort, a total of 203 patients (15%) had unfavorable outcomes. On multivariable analysis, women (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.30-2.94), age ≥72 years (OR 2.80, 95% CI 1.83-4.36), intra/extracranial vascular occlusive lesion (OR 2.80, 95% CI 1.82-4.28), leg weakness (OR 1.72, 95% CI 1.06-2.82), and extinction/inattention (OR 5.55, 95% CI 1.30-21.71) were independently associated with unfavorable outcome. Patients having both a vascular lesion and either leg weakness or extinction/inattention showed 4.63 (95% CI 2.23-9.33) times the risk of unfavorable outcome compared with those having neither. In the validation cohort, the risk was similar, at 3.77 (95% CI 1.64-8.37). CONCLUSIONS: Intra- and extracranial vascular imaging, NIH Stroke Scale items such as leg weakness and extinction/inattention, and their combination, as well as female sex and advanced age, may be useful for predicting unfavorable outcomes in patients with minor stroke.
OBJECTIVES: The purpose of this study was to elucidate the factors that correlate with unfavorable outcomes and to develop a simple validated model for assessing risk of unfavorable outcomes in patients with minor ischemic stroke. METHODS: The derivation cohort included 1,313 patients hospitalized within 72 hours after onset with an initial NIH Stroke Scale score of 0 to 3 enrolled in a prospective, multicenter, observational study. Unfavorable outcome was defined as dependency (modified Rankin Scale score of 3-5) or death at 90 days. The predictive values of factors related to unfavorable outcome were evaluated. External validation was performed in 879 patients from a single-center stroke registry. RESULTS: In the derivation cohort, a total of 203 patients (15%) had unfavorable outcomes. On multivariable analysis, women (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.30-2.94), age ≥72 years (OR 2.80, 95% CI 1.83-4.36), intra/extracranial vascular occlusive lesion (OR 2.80, 95% CI 1.82-4.28), leg weakness (OR 1.72, 95% CI 1.06-2.82), and extinction/inattention (OR 5.55, 95% CI 1.30-21.71) were independently associated with unfavorable outcome. Patients having both a vascular lesion and either leg weakness or extinction/inattention showed 4.63 (95% CI 2.23-9.33) times the risk of unfavorable outcome compared with those having neither. In the validation cohort, the risk was similar, at 3.77 (95% CI 1.64-8.37). CONCLUSIONS: Intra- and extracranial vascular imaging, NIH Stroke Scale items such as leg weakness and extinction/inattention, and their combination, as well as female sex and advanced age, may be useful for predicting unfavorable outcomes in patients with minor stroke.
Authors: D Strbian; A Meretoja; F J Ahlhelm; J Pitkäniemi; P Lyrer; M Kaste; S Engelter; T Tatlisumak Journal: Neurology Date: 2012-02-07 Impact factor: 9.910
Authors: Gustavo Saposnik; Stavroula Raptis; Moira K Kapral; Ying Liu; Jack V Tu; Muhammad Mamdani; Peter C Austin Journal: Stroke Date: 2011-09-29 Impact factor: 7.914
Authors: Heidi Sucharew; Jane Khoury; Charles J Moomaw; Kathleen Alwell; Brett M Kissela; Samir Belagaje; Opeolu Adeoye; Pooja Khatri; Daniel Woo; Matthew L Flaherty; Simona Ferioli; Laura Heitsch; Joseph P Broderick; Dawn Kleindorfer Journal: Stroke Date: 2013-05-23 Impact factor: 7.914
Authors: Shelagh B Coutts; Jayesh Modi; Shiel K Patel; Heidi Aram; Andrew M Demchuk; Mayank Goyal; Michael D Hill Journal: Stroke Date: 2012-09-13 Impact factor: 7.914
Authors: Salma Ahmed Ayis; Bolaji Coker; Anthony G Rudd; Martin S Dennis; Charles D A Wolfe Journal: J Neurol Neurosurg Psychiatry Date: 2012-11-01 Impact factor: 10.154
Authors: Shadi Yaghi; Charlotte Herber; Amelia K Boehme; Howard Andrews; Joshua Z Willey; Sara K Rostanski; Matthew Siket; Mahesh V Jayaraman; Ryan A McTaggart; Karen L Furie; Randolph S Marshall; Ronald M Lazar; Bernadette Boden-Albala Journal: J Neuroimaging Date: 2017-01-09 Impact factor: 2.486
Authors: Shadi Yaghi; Joshua Z Willey; Howard Andrews; Amelia K Boehme; Randolph S Marshall; Bernadette Boden-Albala Journal: Neurohospitalist Date: 2016-04-05
Authors: H Nishi; N Hosomi; K Ohta; S Aoki; M Nakamori; T Nezu; H Shigeishi; T Shintani; T Obayashi; K Ishikawa; N Kinoshita; Y Shiga; M Sugiyama; H Ohge; H Maruyama; H Kawaguchi; H Kurihara Journal: Clin Exp Immunol Date: 2020-03-24 Impact factor: 4.330
Authors: Aleksandra Yakhkind; Ryan A McTaggart; Mahesh V Jayaraman; Matthew S Siket; Brian Silver; Shadi Yaghi Journal: Front Neurol Date: 2016-06-10 Impact factor: 4.003