Abstract T MP10: Pittsburgh Response to Endovascular Therapy (PRE) Score Predicts Likelihood of Benefit From Endovascular Therapy in Anterior Circulation Large Vessel Occlusions
Background: Endovascular therapy seems to benefit a subset of patients with acute large vessel occlusions (LVO). The aim of this study was to develop a clinically useful tool to identify patients with anterior circulation large vessel occlusions who are likely to benefit from endovascular therapy.
Methods: Adults with anterior circulation LVOs were included. In the derivation cohort (2008-2012) from Grady Memorial hospital (GMH), independent predictors (p<0.2) of good outcome (mRS 0-2 at 90 days) were determined using logistic regression. Highly weighted factors were used to derive the PRE score as a predictor of good outcome. Four risk-quartiles were created based on observed rates of good outcomes. The PRE score was validated in the UPMC database (n=322, 2007-2013) and in a database from Unitat d'Ictus Vall d'Hebron (UIVH), Barcelona (n=203, 2009-2012). Performance of PRE was compared with HIAT-2, THRIVE and ASPECTS in predicting good outcome.
Results: In the derivation cohort (N=247, mean age 66±1, median NIHSS 18), independent predictors of good outcome included age (OR 0.96, 0.94-0.98), NIHSS (OR 0.92, 0.87-0.98) and ASPECTS (OR 1.96, 1.6-2.5). The PRE score was calculated as follows: PRE Score = Age + 2 x NIHSS - 10 x ASPECTS. PRE predicted good outcomes in the derivation cohort (AUC 0.79) as well as in the validation cohorts (UPMC: AUC 0.79 and UIVH: AUC 0.72) and comparative rates of good outcome were observed in the four PRE quartiles. PRE < 25 was associated with good outcome (OR 6.0, 3.5-10.5), and controlling for TICI 2B/3 reperfusion status further strengthened this association (OR 12.8, 4.5-36.2). PRE (AUC 0.79) performed better than HIAT2 (AUC 0.75), THRIVE (AUC 0.73) and ASPECTS (AUC 0.57) in predicting good outcomes after endovascular therapy.
Conclusions: The PRE score is a validated tool to predict benefit from endovascular therapy in patients with anterior circulation LVO. PRE can aid in the selection of patients for endovascular reperfusion therapy.
Author Disclosures: S. Rangaraju: None. A. Aghaebrahim: None. C. Streib: None. C. Sun: None. M. Ribo: None. M. Muchada: None. R. Nogueira: Other Research Support; Modest; Stryker Neurovascular: PI for DAWN and TREVO. Consultant/Advisory Board; Modest; Covidien (Steering Committee for SWIFT and SWIFT Trials; Core Lab for STAR Trial), Penumbra (Executive Committe for 3D Separator Trial). Other; Modest; Rapid Medical (DSMB for Rapid Stroke Trial). F. Michael: None. R. Gupta: Honoraria; Modest; UpToDate. Consultant/Advisory Board; Modest; Stryker Neurovascular, Covidien, Rapid Medical. Other; Modest; Associate Editor Journal of Neuroimaging and Interventional Neurology. A.P. Jadhav: None. T.G. Jovin: Consultant/Advisory Board; Modest; consulting and speaker fees from Co-Axia, ev3, Concentric Medical, and Micrus..
- © 2014 by American Heart Association, Inc.