Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke

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

doi:10.1161/STROKEAHA.113.001050

Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke

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 DannenbaumJeffrey L. Saver, David S. Liebeskind, Raul G. Nogueira, Rishi Gupta, James C. Grotta, Sean I. Savitz

Research output: Contribution to journal › Article › peer-review

78 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	3324-3330
Number of pages	7
Journal	Stroke
Volume	44
Issue number	12
DOIs	https://doi.org/10.1161/STROKEAHA.113.001050
State	Published - Dec 2013
Externally published	Yes

Keywords

Acute ischemic stroke
HIAT2
Intra-arterial therapy
Prediction scores
Thrombolysis

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialized Nursing

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10.1161/STROKEAHA.113.001050

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Sarraj, A., Albright, K., Barreto, A. D., Boehme, A. K., Sitton, C. W., Choi, J., Lutzker, S. L., Sun, C. H. J., Bibars, W., Nguyen, C. B., Mir, O., Vahidy, F., Wu, T. C., Lopez, G. A., Gonzales, N. R., Edgell, R., Martin-Schild, S., Hallevi, H., Chen, P. R., ... Savitz, S. I. (2013). Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke. Stroke, 44(12), 3324-3330. https://doi.org/10.1161/STROKEAHA.113.001050

Sarraj, A, Albright, K, Barreto, AD, Boehme, AK, Sitton, CW, Choi, J, Lutzker, SL, Sun, CHJ, Bibars, W, Nguyen, CB, Mir, O, Vahidy, F, Wu, TC, Lopez, GA, Gonzales, NR, Edgell, R, Martin-Schild, S, Hallevi, H, Chen, PR, Dannenbaum, M, Saver, JL, Liebeskind, DS, Nogueira, RG, Gupta, R, Grotta, JC & Savitz, SI 2013, 'Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke', Stroke, vol. 44, no. 12, pp. 3324-3330. https://doi.org/10.1161/STROKEAHA.113.001050

@article{cfda3beef0fd44679f73a123da0ae8e3,

title = "Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke",

abstract = "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.",

keywords = "Acute ischemic stroke, HIAT2, Intra-arterial therapy, Prediction scores, Thrombolysis",

author = "Amrou Sarraj and Karen Albright and Barreto, {Andrew D.} and Boehme, {Amelia K.} and Sitton, {Clark W.} and Jeanie Choi and Lutzker, {Steven L.} and Sun, {Chung Huan J.} and Wafi Bibars and Nguyen, {Claude B.} and Osman Mir and Farhaan Vahidy and Wu, {Tzu Ching} and Lopez, {George A.} and Gonzales, {Nicole R.} and Randall Edgell and Sheryl Martin-Schild and Hen Hallevi and Chen, {Peng Roc} and Mark Dannenbaum and Saver, {Jeffrey L.} and Liebeskind, {David S.} and Nogueira, {Raul G.} and Rishi Gupta and Grotta, {James C.} and Savitz, {Sean I.}",

year = "2013",

month = dec,

doi = "10.1161/STROKEAHA.113.001050",

language = "English (US)",

volume = "44",

pages = "3324--3330",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "12",

}

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

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DO - 10.1161/STROKEAHA.113.001050

M3 - Article

C2 - 23929748

AN - SCOPUS:84889264683

SN - 0039-2499

VL - 44

SP - 3324

EP - 3330

JO - Stroke

JF - Stroke

IS - 12

ER -

Optimizing prediction scores for poor outcome after intra-arterial therapy in anterior circulation acute ischemic stroke

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ASJC Scopus subject areas

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