Abstract 4039: Validation Of The Totaled Heath Risks in Vascular Events (THRIVE) Score For Predicting Outcomes After Endovascular Stroke Treatment
Background: We recently developed a novel clinical prediction tool, the Totaled Health Risks in Vascular Events (THRIVE) score, that predicts outcomes after endovascular stroke treatment. The THRIVE score, which incorporates age, NIH Stroke Scale (NIHSS) score, and three medical comorbidities (hypertension, diabetes mellitus, and atrial fibrillation), was developed using data from the MERCI and Multi MERCI Trials, two clinical trials of the Merci family of endovascular stroke treatment devices.
Methods: In order to perform external validation to demonstrate the reliability of our prediction tool, we applied the THRIVE score to patients from the Merci Registry, the largest clinical series of patients to date undergoing endovascular stroke treatment. We examined the predictive utility of the THRIVE score across the range of clinical outcomes and used Receiver-Operator Characteristics curve analysis and ordinal logistic regression to formally compare score performance in the two data sets.
Results: We find that the THRIVE score predicts good outcome, death, and the full range of the modified Rankin Scale in a similar fashion between the MERCI Trials and the Merci Registry. In Receiver-Operator Characteristics curve comparisons, the area under the curve (AUC) for the ROC curves for good outcome was not significantly different between MERCI Trial patients (AUC = 0.293, 95% C.I. = 0.231 to 0.355) and Merci Registry patients (AUC = 0.266, 95% C.I. = 0.230 to 0.302) (P = 0.47), and the AUC for the ROC curves for death was not significantly different between MERCI Trial patients (AUC = 0.692, 95% C.I. = 0.632 to 0.752) and Merci Registry patients (AUC = 0.717, 95% C.I. = 0.683 to 0.750) (P = 0.48). The THRIVE score (0 to 9) predicts mRS (0 to 6) in ordinal logistic regression in a similar fashion for the MERCI Trials (OR = 1.47, 95% C.I. 1.31 to 1.65, P < 0.001) and the Merci Registry (OR = 1.61, 95% C.I. 1.51 to 1.72, P < 0.001).
Conclusion: The THRIVE score reliably predicts outcomes after endovascular stroke treatment. The THRIVE score may be useful as a prognostic tool in clinical practice and as a means to perform severity adjustments in clinical stroke research. A THRIVE score calculator is available at www.thrivescore.org
- © 2012 by American Heart Association, Inc.