IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. Issue 4 (June 2020)

• Record Type: Journal Article
• Authors: Cappellari, Manuel; Mangiafico, Salvatore; Saia, Valentina; Pracucci, Giovanni; Nappini, Sergio; Nencini, Patrizia; Konda, Daniel; Sallustio, Fabrizio; Vallone, Stefano; Zini, Andrea; Bracco, Sandra; Tassi, Rossana; Bergui, Mauro; Cerrato, Paolo; Pitrone, Antonio; Grillo, Francesco; Saletti, Andrea; De Vito, Alessandro; Gasparotti, Roberto; Magoni, Mauro; Puglielli, Edoardo; Casalena, Alfonsina; Causin, Francesco; Baracchini, Claudio; Castellan, Lucio; Malfatto, Laura; Menozzi, Roberto; Scoditti, Umberto; Comelli, Chiara; Duc, Enrica; Comai, Alessio; Franchini, Enrica; Cosottini, Mirco; Mancuso, Michelangelo; Peschillo, Simone; De Michele, Manuela; Giorgianni, Andrea; Luisa Delodovici, Maria; Lafe, Elvis; Denaro, Maria F; Burdi, Nicola; Internò, Saverio; Cavasin, Nicola; Critelli, Adriana; Chiumarulo, Luigi; Petruzzellis, Marco; Doddi, Marco; Carolei, Antonio; Auteri, William; Petrone, Alfredo; Padolecchia, Riccardo; Tassinari, Tiziana; Pavia, Marco; Invernizzi, Paolo; Turcato, Gianni; Forlivesi, Stefano; Francesca Maria Ciceri, Elisa; Bonetti, Bruno; Inzitari, Domenico; Toni, Danilo;
• Is Part Of: International journal of stroke. Volume 15:Issue 4(2020)
• Page Start: 412
• Page End: 420
• Publication Date: 2020-06
• Subjects: Acute stroke therapy -- thrombectomy -- endovascular treatment -- thrombolysis -- outcome -- nomogram; 616.8005
• DOI: 10.1177/1747493019837756
• Languages: English
• ISSNs: 1747-4930

Abstract

Background: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance. Aims: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset. Methods: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3–6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC). Results: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816–0.869) in the training set, and 0.820 (95% CI: 0.786–0.854) in the test set. Conclusions: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.