(Stroke. 2000;31:456.)
© 2000 American Heart Association, Inc.
Original Contributions |
The Stroke Prognosis Instrument II (SPI-II)
A Clinical Prediction Instrument for Patients With Transient Ischemia and Nondisabling Ischemic Stroke
From the Departments of Internal Medicine (W.N.K., C.M.V., R.I.H.), Epidemiology and Public Health (L.M.B., R.W.M., R.I.H.), Neurology (L.M.B.), Psychiatry (P.M.S.), and Obstetrics and Gynecology (P.M.S.), Yale University School of Medicine, New Haven, Conn; Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University (R.S.S., M.G.) and Clinical Trials Methodology Group, Hamilton Civic Hospitals Research Centre (M.G.), Hamilton, Ontario, Canada; Department of Clinical Neurology, University of Oxford, England (P.R.); and Neurological Institute, Columbia University School of Medicine, New York, NY (R.L.S., R-C.L., B.B-A.).
Background and Purpose—In 1991 we developed the Stroke Prognosis Instrument (SPI-I) to stratify patients with transient ischemic attack or ischemic stroke by prognosis for stroke or death in 2 years. In this article we validate and improve SPI-I (creating SPI-II).
Methods—To validate SPI-I, we applied it to 4 test cohorts and calculated pooled outcome rates. To create SPI-II, we incorporated new predictive variables identified in 1 of the test cohorts and validated it in the other 3 cohorts.
Results—For SPI-I, pooled rates (all 4 test cohorts) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 24%, respectively (P<0.01, log-rank test). SPI-II was created by adding congestive heart failure and prior stroke to SPI-I. Each patient’s risk group was determined by the total score for 7 factors: congestive heart failure (3 points); diabetes (3 points); prior stroke (3 points); age >70 years (2 points); stroke for the index event (not transient ischemic attack) (2 points); hypertension (1 point); and coronary artery disease (1 point). Risk groups I, II, and III comprised patients with 0 to 3, 4 to 7, and 8 to 15 points, respectively. For SPI-I, pooled rates (3 cohorts excluding the SPI-II development cohort) of stroke or death within 2 years in risk groups I, II, and III were 9%, 17%, and 23%, respectively. For SPI-II, pooled rates were 10%, 19%, and 31%, respectively. In receiver operator characteristic analysis, the area under the curve was 0.59 (95% CI, 0.57 to 0.60) for SPI-I and 0.63 (95% CI, 0.62 to 0.65) for SPI-II, confirming the better performance of the latter.
Conclusions—Compared with SPI-I, SPI-II achieves greater discrimination in outcome rates among risk groups. SPI-II is ready for use in research design and may have a role in patient counseling.
Key Words: cerebral infarction • cerebral ischemia, transient • cerebrovascular disorders • prognosis • randomized controlled trials
This article has been cited by other articles:
 |
|
 |
|
  H. Bang, M. Mazumdar, G. Newman, A. S. Bomback, C. M. Ballantyne, A. S. Jaffe, P. A. August, and A. V. Kshirsagar Screening for kidney disease in vascular patients: SCreening for Occult REnal Disease (SCORED) experience Nephrol. Dial. Transplant., March 26, 2009; (2009) gfp124v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Quinn, A. C. Cameron, J. Dawson, K. R. Lees, and M. R. Walters ABCD2 Scores and Prediction of Noncerebrovascular Diagnoses in an Outpatient Population: A Case-Control Study Stroke, March 1, 2009; 40(3): 749 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Weimar, H.-C. Diener, M. J. Alberts, P. G. Steg, D. L. Bhatt, P. W.F. Wilson, J.-L. Mas, J. Rother, and on behalf of the REACH Registry Investigators The Essen Stroke Risk Score Predicts Recurrent Cardiovascular Events: A Validation Within the REduction of Atherothrombosis for Continued Health (REACH) Registry Stroke, February 1, 2009; 40(2): 350 - 354. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Weimar, M Goertler, J Rother, E B Ringelstein, H Darius, D G Nabavi, I.-H. Kim, J. Benemann, H.-C. Diener, and on behalf of the SCALA Study Group Predictive value of the Essen Stroke Risk Score and Ankle Brachial Index in acute ischaemic stroke patients from 85 German stroke units J. Neurol. Neurosurg. Psychiatry, December 1, 2008; 79(12): 1339 - 1343. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ois, M. Gomis, A. Rodriguez-Campello, E. Cuadrado-Godia, J. Jimenez-Conde, C. Pont-Sunyer, G. Cuccurella, and J. Roquer Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke Stroke, June 1, 2008; 39(6): 1717 - 1721. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Purroy, C. A. Molina, J. Montaner, and J. Alvarez-Sabin Absence of Usefulness of ABCD Score in the Early Risk of Stroke of Transient Ischemic Attack Patients Stroke, March 1, 2007; 38(3): 855 - 856. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S.V. Elkind, A. C. Flint, R. R. Sciacca, and R. L. Sacco Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality Neurology, July 26, 2005; 65(2): 253 - 258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S.V. Elkind Implications of stroke prevention trials: Treatment of global risk Neurology, July 12, 2005; 65(1): 17 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sacco, J. Sivenius, and H.-C. Diener Efficacy of Aspirin Plus Extended-Release Dipyridamole in Preventing Recurrent Stroke in High-Risk Populations Arch Neurol, March 1, 2005; 62(3): 403 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. N. Kernan, C. M. Viscoli, S. E. Inzucchi, L. M. Brass, D. M. Bravata, G. I. Shulman, and J. C. McVeety Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke Arch Intern Med, January 24, 2005; 165(2): 227 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Alamowitch, M. Eliasziw, H. J.M. Barnett, and for the North American Symptomatic Carotid Endarte The Risk and Benefit of Endarterectomy in Women With Symptomatic Internal Carotid Artery Disease Stroke, January 1, 2005; 36(1): 27 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Daffertshofer, O. Mielke, A. Pullwitt, M. Felsenstein, and M. Hennerici Transient Ischemic Attacks Are More Than "Ministrokes" Stroke, November 1, 2004; 35(11): 2453 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. G. Nadareishvili, H. Li, V. Wright, D. Maric, S. Warach, J. M. Hallenbeck, J. Dambrosia, J. L. Barker, and A. E. Baird Elevated pro-inflammatory CD4+CD28- lymphocytes and stroke recurrence and death Neurology, October 26, 2004; 63(8): 1446 - 1451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Purroy, J. Montaner, A. Rovira, P. Delgado, M. Quintana, and J. Alvarez-Sabin Higher Risk of Further Vascular Events Among Transient Ischemic Attack Patients With Diffusion-Weighted Imaging Acute Ischemic Lesions Stroke, October 1, 2004; 35(10): 2313 - 2319. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Fox Poststroke patients: implications for the cardiologist Eur. Heart J. Suppl., July 1, 2003; 5(suppl_E): E4 - E10. [Abstract] [PDF]
|
|
|
|
|
|
T G Clark, M F G Murphy, and P M Rothwell Long term risks of stroke, myocardial infarction, and vascular death in "low risk" patients with a non-recent transient ischaemic attack J. Neurol. Neurosurg. Psychiatry, May 1, 2003; 74(5): 577 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Bravata, S.-Y. Ho, L. M. Brass, J. Concato, J. Scinto, and T. P. Meehan Long-Term Mortality in Cerebrovascular Disease Stroke, March 1, 2003; 34(3): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.J. Cunningham, R. Bond, Z. Mehta, M.R. Mayberg, C.P. Warlow, and P.M. Rothwell Long-Term Durability of Carotid Endarterectomy for Symptomatic Stenosis and Risk Factors for Late Postoperative Stroke Stroke, November 1, 2002; 33(11): 2658 - 2663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S.V. Elkind Implications of stroke prevention trials: Treatment of global risk Neurology, July 12, 2005; 65(1): 17 - 21. [Abstract] [Full Text] [PDF]
|
|