Predictive value of the Essen Stroke Risk Score and Ankle Brachial Index in acute ischaemic stroke patients from 85 German stroke units
- C Weimar1,
- M Goertler2,
- J Röther3,
- E B Ringelstein4,
- H Darius5,
- D G Nabavi6,
- In-Ha Kim7,
- Jens Benemann1,
- Hans-Christoph Diener1,
- on behalf of the SCALA Study Group
- 1Department of Neurology, University of Duisburg-Essen, Essen, Germany
- 2Department of Neurology, University of Magdeburg, Magdeburg, Germany
- 3Department of Neurology, Klinikum Minden, Minden, Germany
- 4Department of Neurology, University of Muenster, Muenster, Germany
- 5Department of Cardiology, Vivantes Hospital Neukoelln, Berlin, Germany
- 6Department of Neurology, Vivantes Hospital Neukoelln, Berlin, Germany
- 7Medical Department, Sanofi-Aventis, Paris, France
- Dr C Weimar, Department of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, D- 45122 Essen, Germany; stroke.med{at}uni-essen.de
- Received 6 February 2008
- Revised 9 March 2008
- Accepted 13 March 2008
- Published Online First 27 June 2008
Abstract
Background: Risk stratification can contribute to individualised optimal secondary prevention in patients with cerebrovascular disease.
Objective: To prospectively investigate the prediction of the Essen Stroke Risk Score (ESRS) and a pathological Ankle Brachial Index (ABI) in consecutive patients hospitalised with acute ischaemic stroke or transient ischaemic attack (TIA) in 85 neurological stroke units throughout Germany.
Methods: 852 patients were prospectively documented on standardised case report forms, including assessment of ESRS and ABI. After 17.5 months, recurrent cerebrovascular events, functional outcome or death could be assessed in 729 patients predominantly via central telephone interview.
Results: After discharge from the documenting hospital, recurrent stroke occurred in 41 patients (5.6%) and recurrent TIA in 15 patients (2.1%). 52 patients (7.1%) had died, 33 (4.5%) from cardiovascular causes. Patients with an ESRS ≥3 (vs <3) had a significantly higher risk of recurrent stroke or cardiovascular death (9.7% vs 5.1%; odds ratio (OR) 2.00, 95% confidence interval (CI) 1.08 to 3.70) and a higher recurrent stroke risk (6.9% vs 3.7%; OR 1.93, 95% CI 0.95 to 3.94). Patients with an ABI ≤0.9 (vs >0.9) had a significantly higher risk of recurrent stroke or cardiovascular death (10.4% vs 5.5%; OR 2.00, 95% CI 1.12 to 3.56) and a higher recurrent stroke risk (6.6% vs 4.6%; OR 1.47, 95% CI 0.76 to 2.83).
Conclusion: Our prospective follow-up study shows a significantly higher rate of recurrent stroke or cardiovascular death and a clear trend for a higher rate of recurrent stroke in patients with acute cerebrovascular events classified as high risk by an ESRS ≥3 or a pathological ABI.
Footnotes
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The appendix is published online only at http://jnnp.bmj.com/content/vol79/issue12
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Funding: This study was funded by Sanofi-Aventis, Berlin, Germany. The company was involved in the original concept, design, choice of investigators, control of allocation schedule, conduct of the trial, collection and monitoring of baseline data under close supervision by the members of the steering committee (all of whom are listed as authors on this paper).
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Competing interests: None.
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Ethics approval: The study was approved by the ethics committee of the University of Essen and conducted according to national data protection legislation.
