A modified Essen stroke risk score for predicting recurrent cardiovascular events: development and validation

Authors


  • Conflicts of interests: S. S. has no conflicts of interest. H. O. has received research funding from Sanofi-aventis. K. H. has received honoraria from Sanofi-aventis, Pfizer Japan, Mitsubishi Tanabe Pharma, Otsuka Pharmaceutical, and Novartis Pharma. Y. T. has received consultancy fees, honoraria, and travel grants from Sanofi-aventis. S. U. has received consultant fees, support for travel to meetings, participation in reviewing activities, and lecture fees, and his institution received grants from Otsuka Pharmaceutical, Sanofi-aventis, Boehringer Ingelheim, Daiichi-Sankyo, and Bayer Healthcare. H. D. has received consultant fees, honoraria, and travel grants from Sanofi-aventis. H. S. has received consultancy fees and lecture fees from Sanofi-aventis, Otsuka Pharmaceutical, Kowa, Daiichi-Sankyo, Astellas Pharma, and Mitsubishi Tanabe Pharma. S. G. has received consultant fees, honoraria, and travel grants from Sanofi-aventis. K. T. has received research funding from Eisai, Otsuka Pharmaceutical, Sanofi-aventis, and Boehringer Ingelheim, and lecture fees from Otsuka Pharmaceutical, Boehringer Ingelheim, Mochida Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi-aventis. S. M. has received honoraria from Sanofi-aventis. K. M. has received research funding from Sanofi-aventis, and lecture fees from Sanofi-aventis, Otsuka Pharmaceutical, and Bayer Healthcare. M. M. has no conflicts of interest. Y. O. has received honoraria from Sanofi-aventis, Otsuka Pharmaceutical, Mitsubishi Tanabe Pharma, Pfizer Japan, Bayer Healthcare, and Boehringer Ingelheim. M. S. has no conflicts of interest. N. S. has received research funding from Sanofi-aventis, and lecture fees from Sanofi-aventis, and Otsuka Pharmaceutical.
  • Grant support: The EVEREST Registry is sponsored by Sanofi-aventis K. K.

Correspondence: Hideki Origasa*, Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.

E-mail: horigasa@las.u-toyama.ac.jp

Abstract

Background

The Essen stroke risk score is widely applied to predict the risk of recurrent ischemic stroke. We developed a modified Essen stroke risk score and validated it using a large prospective Effective Vascular Event REduction after STroke (EVEREST) registry including 3588 patients with ischemic stroke in Japan. Patients with cardioembolic stroke were excluded, and follow-up was one-year.

Methods

The modified Essen stroke risk score was calculated from scores for waist circumference, stroke subtype by etiology, and gender in addition to age, hypertension, diabetes mellitus, previous myocardial infarction, other cardiovascular diseases except myocardial infarction and atrial fibrillation, peripheral artery disease, smoking, and previous stroke or transient ischemic attack. A multiple logistic regression model identified the predictors (each assigned one or two points) and provided c-statistics for the modified Essen stroke risk score. We considered two outcomes, recurrent ischemic stroke and cardiovascular events (defined as the combined outcomes of fatal or nonfatal stroke, myocardial infarction, nonfatal unstable angina, and cardiac death).

Results

Recurrent ischemic stroke occurred in 121 patients (3·7%) and cardiovascular events occurred in 133 (4·0%) within a year. The c-statistic (used for discrimination) was 0·632 for recurrent stroke and 0·640 for cardiovascular events. Patients scoring 6 or greater were classified as high risk, otherwise were classified as low risk. Kaplan–Meier analysis revealed that the modified risk score was more predictive than the Essen stroke risk score in both men and women.

Conclusions

The modified Essen stroke risk score increased the ability of the Essen stroke risk score to predict recurrent cardiovascular events. Patients with a high modified Essen stroke risk score should be candidates for intensified secondary prevention strategies.

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