The Essen stroke risk score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for Continued Health (REACH) registry.
OBJECTIVE
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 15605 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.
Weimar
Christian
C
Department of Neurology, University of Duisburg-Essen, Essen, Germany. stroke.med@uni-due.de
Diener
Hans-Christoph
HC
Alberts
Mark J
MJ
Steg
P Gabriel
PG
Bhatt
Deepak L
DL
Wilson
Peter W F
PW
Mas
Jean-Louis
JL
Röther
Joachim
J
D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D012008:Recurrence; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality