Validation of the Stroke Prognostic Instrument-II in a Large, Modern, Community-Based Cohort of Ischemic Stroke Survivors

Abstract

Background and Purpose-The risk of recurrent stroke in the modern era of secondary stroke prevention is not well defined. Several prediction models, including the Stroke Prognostic Instrument-II (SPI-II), have been created to identify patients at highest risk, but their performance in modern populations has been infrequently tested. We aimed to assess the 1-year risk of recurrence after hospital discharge in a recent, large, community-based cohort of patients with ischemic stroke and to validate the SPI-II prediction model in this cohort. Methods-From 2004 through 2006, 5575 patients with acute ischemic stroke were prospectively identified and followed for recurrent events. Kaplan-Meier statistics were used to analyze the cumulative incidence of recurrent ischemic stroke. Harrell c-statistic was calculated to determine the performance of SPI-II in predicting stroke or death at 1 year, and the log-rank test was used to compare the differences among low-, middle-, and high-risk groups. Results-Among 5575 patients with ischemic stroke, recurrence was observed in 221 during the subsequent year.Kaplan-Meier estimates of cumulative rates of recurrent stroke were 2.5%, 3.6%, and 4.8% at 3, 6, and 12 months, respectively. Rates of stroke or death for SPI-II in the low-, middle-, and high-risk groups were 8.2%, 24.5%, and 35.6%, respectively (trend, Pϭ0.001). The c-statistic for SPI-II was 0.62 (95% CI, 0.61-0.64). Conclusions-The modern 1-year rate of recurrent stroke after hospital discharge is low but still substantial at 4.8%.SPI-II is a modestly effective tool in identifying patients with ischemic stroke at highest risk of developing recurrence or death. (Stroke. 2011;42:3392-3396.)

Recurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors

“…(5, 26, 27) Patients with primary brain tumors experienced a short-term recurrent stroke rate that was approximately double the recurrent stroke rate observed in the general population. (6) We did not find any significant independent predictors of recurrent thromboembolism. Patients with radiation vasculopathy appeared to face double the risk of recurrent stroke, although this trend was nonsignificant.…”

“…Roughly one-third of cancer patients with stroke develop a recurrent thromboembolic event by 3 months, and 13% develop recurrent ischemic stroke, which is approximately three times the expected rate in non-cancer patients. (5, 6) Moreover, the median survival after ischemic stroke in this population is 84 days. (5) The high risk of recurrent thromboembolism and death after stroke in the systemic cancer population is partly due to cancer-associated coagulopathy, a well-recognized non-traditional stroke mechanism correlating with heightened cancer activity.…”

Warfarin-Associated Intracerebral Hemorrhage After Ischemic Stroke

“…3,4 These variations can be explained by methodological differences, such as the exclusion of early stroke recurrence (<28 days) in this study. The incidence of warfarin-associated ICH (≈0.4% in both periods) in our study reflected real life, but was lower than data presented for warfarin in trials of NOAC.…”

“…[2][3][4] Although time between stroke and randomization varies (14 daysyears), subgroup analyses of new oral anticoagulant (NOAC) trials offer modern insight into the incidence of ICH. [5][6][7] NOAC is an alternative to warfarin, but in the Swedish guidelines for prevention of cardioembolic stroke, warfarin and NOAC have the same recommendation as first-line drugs 8 ; therefore, it is important to recognize both the advantages and disadvantages of warfarin in clinical practice, especially for future comparison with NOAC.…”

Formal and informal prediction of recurrent stroke and myocardial infarction after stroke: a systematic review and evaluation of clinical prediction models in a new cohort

“…We identified four additional evaluations among the model development studies [30,37,39,41] giving fifteen evaluation cohorts: five evaluations of the ESRS [29,37,43-45]; three of the SPI-II [41,46,47]; five head-to-head comparisons of the ESRS and the SPI-II [30,39,48-51]; one head-to-head comparison of the ESRS and the RRE-90 [52]; and one comparing the ESRS, the SPI-II and the LiLAC models [50]. …”