Development and Validation of a Postprocedural Model to Predict Outcome After Endovascular Treatment for Ischemic Stroke
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Published:2023-09-01
Issue:9
Volume:80
Page:940
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ISSN:2168-6149
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Container-title:JAMA Neurology
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language:en
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Short-container-title:JAMA Neurol
Author:
Chalos Vicky123, Venema Esmee24, Mulder Maxim J. H. L.1, Roozenbeek Bob1, Steyerberg Ewout W.5, Wermer Marieke J. H.6, Lycklama à Nijeholt Geert J.7, van der Worp H. Bart8, Goyal Mayank9, Campbell Bruce C. V.10, Muir Keith W.11, Guillemin Francis12, Bracard Serge13, White Philip14, Dávalos Antoni15, Jovin Tudor G.16, Hill Michael D.9, Mitchell Peter J.17, Demchuk Andrew M.9, Saver Jeffrey L.18, van der Lugt Aad3, Brown Scott19, Dippel Diederik W. J.1, Lingsma Hester F.2, Berkhemer Olvert A.20, Fransen Puck S.S.20, Beumer Debbie20, van den Berg Lucie A.20, Lingsma Hester F.20, Yoo Albert J.20, Schonewille Wouter J.20, Vos Jan Albert20, Nederkoorn Paul J.20, Wermer Marieke J.H.20, van Walderveen Marianne A.A.20, Staals Julie20, Hofmeijer Jeannette20, van Oostayen Jacques A.20, Lycklama à Nijeholt Geert J.20, Boiten Jelis20, Brouwer Patrick A.20, Emmer Bart J.20, de Bruijn Sebastiaan F.20, van Dijk Lukas C.20, Kappelle L. Jaap20, Lo Rob H.20, van Dijk Ewoud J.20, de Vries Joost20, de Kort Paul L.M.20, van Rooij Willem Jan. J.20, van den Berg Jan S.P.20, van Hasselt Boudewijn A.A.M.20, Aerden Leo A.M.20, Dallinga René J.20, Visser Marieke C.20, Bot Joseph C.J.20, Vroomen Patrick C.20, Eshghi Omid20, Schreuder Tobien H.C.M.L.20, Heijboer Roel J.J.20, Keizer Koos20, Tielbeek Alexander V.20, den Hertog Heleen M.20, Gerrits Dick G.20, van den Berg-Vos Renske M.20, Karas Giorgos B.20, Steyerberg Ewout W.20, Flach H. Zwenneke20, Marquering Henk A.20, Sprengers Marieke E.S.20, Jenniskens Sjoerd F.M.20, Beenen Ludo F.M.20, van den Berg René20, Koudstaal Peter J.20, van Zwam Wim H.20, Roos Yvo B.W.E.M.20, van der Lugt Aad20, van Oostenbrugge Robert J.20, Majoie Charles B.L.M.20, Dippel Diederik W.J.20, Brown Martin M.20, Liebig Thomas20, Stijnen Theo20, Andersson Tommy20, Mattle Heinrich20, Wahlgren Nils20, van der Heijden Esther20, Ghannouti Naziha20, Fleitour Nadine20, Hooijenga Imke20, Puppels Corina20, Pellikaan Wilma20, Geerling Annet20, Lindl-Velema Annemieke20, van Vemde Gina20, de Ridder Ans20, Greebe Paut20, Simons Tiny20, Messchendorp Gert20, van der Minne Friedus20, Aaldering Nicole20, Elfrink Marjan20, de Bont-Stikkelbroeck José20, de Meris Joke20, Janssen Kirsten20, Struijk Willy20, Bongenaar Hester20, Bodde Karin20, Licher Silvan20, Boodt Nikki20, Ros Adriaan20, Venema Esmee20, Slokkers Ilse20, Ganpat Raymie-Jayce20, Mulder Maxim20, Saiedie Nawid20, Hesmatollah Alis20, Schipperen Stefanie20, Vinken Stefan20, van Boxel Tiemen20, Koets Jeroen20, Broers Merel20, Santos Emilie20, Borst Jordi20, Jansen Ivo20, Kappelhof Manon20, Lucas Marit20, Geuskens Ralph20, Sales Barros Renan20, Dobbe Roeland20, Csizmadia Marloes20, Hill M.D.20, Goyal Mayank20, Demchuk Andrew M.20, Menon Bijoy K.20, Eesa M.20, Ryckborst K.J.20, Wright M.R.20, Kamal N.R.20, Andersen L.20, Randhawa P.A.20, Stewart T.20, Patil S.20, Minhas P.20, Almekhlafi Mohammed A.20, Mishra S.20, Clement F.20, Sajobi T.20, Shuaib A.20, Montanera W.J.20, Roy D.20, Silver F.L.20, Jovin T.G.20, Frei D.F.20, Sapkota B.20, Rempel J.L.20, Thornton J.20, Williams D.20, Tampieri D.20, Poppe A.Y.20, Dowlatshahi D.20, Wong J.H.20, Mitha A.P.20, Subramaniam S.20, Lowerison M.W.20, Salluzzi M.20, Maxwell M.20, Lacusta S.20, Drupals E.20, Armitage K.20, Barber P.A.20, Smith E.E.20, Morrish W.F.20, Coutts S.B.20, Derdeyn C.20, Demaerschalk B.20, Yavagal D.20, Martin R.20, Brant R.20, Yu Y.20, Willinsky R.A.20, Weill A.20, 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T.20, McCabe D.20, O'Neill D.20, Mulroy M.20, Lynch O.20, Walsh T.20, O'Donnell M.20, Galvin T.20, Harbison J.20, McElwaine P.20, Mulpeter K.20, McLoughlin C.20, Raerdon M.20, Harkin E.20, Dolan E.20, Watts M.20, Cunningham N.20, Fallon C.20, Gallagher S.20, Cotter P.20, Crowe M.20, Doyle R.20, Noone I.20, Lapierre M.20, Coté V.A.20, Lanthier S.20, Odier C.20, Durocher A.20, Raymond J.20, Daneault N.20, Deschaintre Y.20, Jovin T.20, Jankowitz B.20, Baxendell L.20, Massaro L.20, Jackson-Graves C.20, Decesare S.20, Porter P.20, Armbruster K.20, Adams A.20, Billigan J.20, Oakley J.20, Ducruet A.20, Jadhav A.20, Giurgiutiu D.V.20, Aghaebrahim A.20, Reddy V.20, Hammer M.20, Starr M.20, Totoraitis V.20, Wechsler L.20, Streib S.20, Rangaraju S.20, Campbell D.20, Rocha M.20, Gulati D.20, Krings T.20, Kalman L.20, Cayley A.20, Williams J.20, Wiegner R.20, Casaubon L.K.20, Jaigobin C.20, del Campo J.M.20, Schaafsma J.D.20, Agid R.20, Farb R.20, ter Brugge K.20, Sapkoda B.L.20, Baxter B.W.20, 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Ricolfi Frederic20, Ronziere Thomas20, Saliou Guillaume20, Sibon Igor20, Sedat Jacques20, Stapf Christian20, Suissa Laurent20, Velasco Stephane20, Samson Yves20, Sourour Nader20, Crozier Sophie20, Deltour Sandrine20, Di Maria Federico20, Le Bouc Raphael20, Leger Anne20, Mutlu Gurkan20, Rosso Charlotte20, Szatmary Zoltan20, Yger Marion20, Zavanone Chiara20, Caucheteux Nathalie20, Estrade Laurent20, Kadziolka Krzysztof20, Leautaud Alexandre20, Renkes Céline20, Serre Isabelle20, Desal Hubert20, Boutoleau-Bretonniere Claire20, Daumas-Duport Benjamin20, De Gaalon Solène20, Derkinderen Pascal20, Evain Sarah20, Herisson Fanny20, Laplaud David-Axel20, Lebouvier Thibaud20, Lintia-Gaultier Alina20, Pouclet-Courtemanche Hélène20, Rouaud Tiphaine20, Rouaud Jaffrenou Violaine20, Schunck Aurélia20, Sevin Mathieu20, Toulgoat Fredereque20, Wiertlewski Sandrine20, Gauvrit Jean-Yves20, Cahagne Vincent20, Ferre Jean-Christophie20, Pinel Jean-François20, Meder Jean-François20, Al Najjar-Carpentier 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Tilikete Caroline20, Blanc Raphael20, Bruno Bartolini Marion20, Gueguen Antoine20, Pistocchi Silvia20, Redjem Hocine20, Drouineau Jacques20, Godeneche Gaelle20, Lamy Matthias20, Marsac Emilia20, Clavelou Pierre20, Chabert Emmanuel20, Bourgois Nathalie20, Cornut-Chauvinc Catherine20, Gabrillargues Jean20, Jean Betty20, Marques Anna-Raquel20, Vitello Nicolas20, Barbieux Marianne20, Boubagra Kamel20, Wiki Isabelle F.20, Garambois Katia20, Tahon Florence20, Ashok Vasdev20, Coskun Oguzhan20, Rodesch Georges20, Bourdain Frédéric20, Evrard Serge20, Graveleau Philippe20, Decroix Jean Pierre20, Wang Adrien20, Sellal François20, Ahle Guido20, Carelli Gabriela20, Dugay Marie-Hélène20, Gaultier Claude20, Lebedeinsky Ariel P.20, Lita Lavinia20, Renglewicz-Destuynder Catherine20, Tournade Alain20, Vuillemet Françis20, Montoro Francisco M.20, Mounayer Charbel20, Faugeras Frederic20, Labach Catherine20, Lautrette Géraldine20, Chassin Olivier20, Dussaule Claire20, Melki Elsa20, Ozanne Augustin20, 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Affiliation:
1. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands 2. Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands 3. Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands 4. Department of Emergency Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands 5. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands 6. Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands 7. Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands 8. Department of Neurology and Neurosurgery, University Medical Center Utrecht, Brain Center, Utrecht University, Utrecht, the Netherlands 9. Departments of Clinical Neuroscience and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada 10. Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia 11. Institute of Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, United Kingdom 12. CHRU Nancy, Inserm, Université de Lorraine, CIC Clinical Epidemiology, Nancy, France 13. Department of Diagnostic and Interventional Neuroradiology, University of Lorraine and University Hospital of Nancy, Nancy, France 14. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom 15. Department of Neuroscience, Hospital Germans Trias y Pujol, Barcelona, Spain 16. Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center Stroke Institute, Presbyterian University Hospital, Pittsburgh, Pennsylvania 17. Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia 18. Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of Los Angeles, Los Angeles, California 19. Altair Biostatistics, Mooresville, North Carolina 20. for the HERMES CollaboratorsMR CLEAN Registry Investigators
Abstract
ImportanceOutcome prediction after endovascular treatment (EVT) for ischemic stroke is important to patients, family members, and physicians.ObjectiveTo develop and validate a model based on preprocedural and postprocedural characteristics to predict functional outcome for individual patients after EVT.Design, Setting, and ParticipantsA prediction model was developed using individual patient data from 7 randomized clinical trials, performed between December 2010 and December 2014. The model was developed within the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) collaboration and external validation in data from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry of patients treated in clinical practice between March 2014 and November 2017. Participants included patients from multiple centers throughout different countries in Europe, North America, East Asia, and Oceania (derivation cohort), and multiple centers in the Netherlands (validation cohort). Included were adult patients with a history of ischemic stroke from an intracranial large vessel occlusion in the anterior circulation who underwent EVT within 12 hours of symptom onset or last seen well. Data were last analyzed in July 2022.Main Outcome(s) and Measure(s)A total of 19 variables were assessed by multivariable ordinal regression to predict functional outcome (modified Rankin Scale [mRS] score) 90 days after EVT. Variables were routinely available 1 day after EVT. Akaike information criterion (AIC) was used to optimize model fit vs model complexity. Probabilities for functional independence (mRS 0-2) and survival (mRS 0-5) were derived from the ordinal model. Model performance was expressed with discrimination (C statistic) and calibration.ResultsA total of 781 patients (median [IQR] age, 67 [57-76] years; 414 men [53%]) constituted the derivation cohort, and 3260 patients (median [IQR] age, 72 [61-80] years; 1684 men [52%]) composed the validation cohort. Nine variables were included in the model: age, baseline National Institutes of Health Stroke Scale (NIHSS) score, prestroke mRS score, history of diabetes, occlusion location, collateral score, reperfusion grade, NIHSS score at 24 hours, and symptomatic intracranial hemorrhage 24 hours after EVT. External validation in the MR CLEAN Registry showed excellent discriminative ability for functional independence (C statistic, 0.91; 95% CI, 0.90-0.92) and survival (0.89; 95% CI, 0.88-0.90). The proportion of functional independence in the MR CLEAN Registry was systematically higher than predicted by the model (41% vs 34%), whereas observed and predicted survival were similar (72% vs 75%). The model was updated and implemented for clinical use.Conclusion and relevanceThe prognostic tool MR PREDICTS@24H can be applied 1 day after EVT to accurately predict functional outcome for individual patients at 90 days and to provide reliable outcome expectations and personalize follow-up and rehabilitation plans. It will need further validation and updating for contemporary patients.
Publisher
American Medical Association (AMA)
Subject
Neurology (clinical)
Cited by
1 articles.
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