TY - JOUR
T1 - Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke
AU - Sarraj, Amrou
AU - Albright, Karen
AU - Barreto, Andrew D.
AU - Boehme, Amelia K.
AU - Sitton, Clark W.
AU - Choi, Jeanie
AU - Lutzker, Steven L.
AU - Sun, Chung Huan J.
AU - Bibars, Wafi
AU - Nguyen, Claude B.
AU - Mir, Osman
AU - Vahidy, Farhaan
AU - Wu, Tzu Ching
AU - Lopez, George A.
AU - Gonzales, Nicole R.
AU - Edgell, Randall
AU - Martin-Schild, Sheryl
AU - Hallevi, Hen
AU - Chen, Peng Roc
AU - Dannenbaum, Mark
AU - Saver, Jeffrey L.
AU - Liebeskind, David S.
AU - Nogueira, Raul G.
AU - Gupta, Rishi
AU - Grotta, James C.
AU - Savitz, Sean I.
PY - 2013/12
Y1 - 2013/12
N2 - BACKGROUND AND PURPOSE - Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions. METHODS - Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University. RESULTS - A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60-79=2, ≥80 years=4), glucose (<150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11-20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8-10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score ≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score ≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores. CONCLUSIONS - The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
AB - BACKGROUND AND PURPOSE - Intra-arterial therapy (IAT) promotes recanalization of large artery occlusions in acute ischemic stroke. Despite high recanalization rates, poor clinical outcomes are common. We attempted to optimize a score that combines clinical and imaging variables to more accurately predict poor outcome after IAT in anterior circulation occlusions. METHODS - Patients with acute ischemic stroke undergoing IAT at University of Texas (UT) Houston for large artery occlusions (middle cerebral artery or internal carotid artery) were reviewed. Independent predictors of poor outcome (modified Rankin Scale, 4-6) were studied. External validation was performed on IAT-treated patients at Emory University. RESULTS - A total of 163 patients were identified at UT Houston. Independent predictors of poor outcome (P≤0.2) were identified as score variables using sensitivity analysis and logistic regression. Houston Intra-Arterial Therapy 2 (HIAT2) score ranges 0 to 10: age (≤59=0, 60-79=2, ≥80 years=4), glucose (<150=0, ≥150=1), National Institute Health Stroke Scale (≤10=0, 11-20=1, ≥21=2), the Alberta Stroke Program Early CT Score (8-10=0, ≤7=3). Patients with HIAT2≥5 were more likely to have poor outcomes at discharge (odds ratio, 6.43; 95% confidence interval, 2.75-15.02; P<0.001). After adjusting for reperfusion (Thrombolysis in Cerebral Infarction score ≥2b) and time from symptom onset to recanalization, HIAT2≥5 remained an independent predictor of poor outcome (odds ratio, 5.88; 95% confidence interval, 1.96-17.64; P=0.02). Results from the cohort of Emory (198 patients) were consistent; patients with HIAT2 score ≥5 had 6× greater odds of poor outcome at discharge and at 90 days. HIAT2 outperformed other previously published predictive scores. CONCLUSIONS - The HIAT2 score, which combines clinical and imaging variables, performed better than all previous scores in predicting poor outcome after IAT for anterior circulation large artery occlusions.
KW - Acute ischemic stroke
KW - HIAT2
KW - Intra-arterial therapy
KW - Prediction scores
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=84889264683&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.113.001050
DO - 10.1161/STROKEAHA.113.001050
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C2 - 23929748
AN - SCOPUS:84889264683
SN - 0039-2499
VL - 44
SP - 3324
EP - 3330
JO - Stroke
JF - Stroke
IS - 12
ER -
