on November 20, 2008
Published online before print November 20, 2008, doi: 10.1161/STROKEAHA.108.521419
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Submitted on March 26, 2008
From the Department of Neurology (C.W., H.-C.D.), University of Duisburg-Essen, Essen, Germany; the Division of Neurology (M.J.A.), Northwestern University Medical School, Chicago, Ill; INSERM U-698 and APHP (Hôpital Bichat-Claude Bernard; P.G.S.), Université Paris 7, France; the Department of Cardiovascular Medicine (D.L.B.), Cleveland Clinic, Cleveland, Ohio; the Cardiology Division (P.W.F.W.), Emory University School of Medicine, Atlanta, Ga; Service de Neurologie (J.-L.M.), Centre Raymond Garcin, Hôpital Saint-Anne, Paris, France; and the Department of Neurology (J.R.), Klinikum Minden, Hannover Medical School, Minden, Germany. * To whom correspondence should be addressed. E-mail: stroke.med{at}uni-due.de.
Background and Purpose—Predictive scores are important tools for stratifying patients based on the risk of future (cerebro)vascular events and for selecting potential prevention therapy. Recently, the Essen Stroke Risk Score (ESRS) was derived from cerebrovascular patients in the Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial. We aimed to validate the ESRS in a large cohort of outpatients with previous transient ischemic attack or stroke from the REduction of Atherothrombosis for Continued Health (REACH) Registry. Methods—We included 15 605 outpatients with a qualifying stroke or transient ischemic attack and with clinical follow-up at 1 year. Patients with atrial fibrillation were excluded. We stratified 1-year cumulative rates for fatal and nonfatal stroke as well as combined major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) by the individually calculated stroke risk profile according to the ESRS and compared it with the 1-year event rates in the CAPRIE data subset of 6431 cerebrovascular patients. Results—The 1-year rate for recurrent stroke (or combined cardiovascular events) in the stable outpatient population of REACH increased steadily and significantly from 1.82 (2.41) in patients with ESRS 0 to 6.84 (11.48) for ESRS >6. The overall as well as stratified risk of recurrent stroke and cardiovascular events was lower than for cerebrovascular patients in CAPRIE. Conclusions—In outpatients with previous stroke or transient ischemic attack, the ESRS accurately stratifies the risk of recurrent stroke or major vascular events. Patients with a high ESRS should be candidates for intensified secondary prevention strategies.
Revised on June 7, 2008
Accepted on June 18, 2008
The Essen Stroke Risk Score Predicts Recurrent Cardiovascular Events. A Validation Within the REduction of Atherothrombosis for Continued Health (REACH) Registry
Christian Weimar MD*;
Key words: ischemic stroke • risk prediction • secondary prevention • vascular events