title: A modified Essen stroke risk score for predicting recurrent cardiovascular events: development and validation.
abstract: BACKGROUND
  The Essen stroke risk score is widely applied to predict the risk of recurrent ischemic stroke. We developed a modified Essen stroke risk score and validated it using a large prospective Effective Vascular Event REduction after STroke (EVEREST) registry including 3588 patients with ischemic stroke in Japan. Patients with cardioembolic stroke were excluded, and follow-up was one-year.
  
  
  METHODS
  The modified Essen stroke risk score was calculated from scores for waist circumference, stroke subtype by etiology, and gender in addition to age, hypertension, diabetes mellitus, previous myocardial infarction, other cardiovascular diseases except myocardial infarction and atrial fibrillation, peripheral artery disease, smoking, and previous stroke or transient ischemic attack. A multiple logistic regression model identified the predictors (each assigned one or two points) and provided c-statistics for the modified Essen stroke risk score. We considered two outcomes, recurrent ischemic stroke and cardiovascular events (defined as the combined outcomes of fatal or nonfatal stroke, myocardial infarction, nonfatal unstable angina, and cardiac death).
  
  
  RESULTS
  Recurrent ischemic stroke occurred in 121 patients (3·7%) and cardiovascular events occurred in 133 (4·0%) within a year. The c-statistic (used for discrimination) was 0·632 for recurrent stroke and 0·640 for cardiovascular events. Patients scoring 6 or greater were classified as high risk, otherwise were classified as low risk. Kaplan-Meier analysis revealed that the modified risk score was more predictive than the Essen stroke risk score in both men and women.
  
  
  CONCLUSIONS
  The modified Essen stroke risk score increased the ability of the Essen stroke risk score to predict recurrent cardiovascular events. Patients with a high modified Essen stroke risk score should be candidates for intensified secondary prevention strategies.
authors: Department of Biostatistics, Graduate School of Medicine, Kurume University, Kurume, Japan.
authors: Shigeki
authors: S
authors: Sumi
authors: Hideki
authors: H
authors: Origasa
authors: Kiyohiro
authors: K
authors: Houkin
authors: Yasuo
authors: Y
authors: Terayama
authors: Shinichiro
authors: S
authors: Uchiyama
authors: Hiroyuki
authors: H
authors: Daida
authors: Hiroshi
authors: H
authors: Shigematsu
authors: Shinya
authors: S
authors: Goto
authors: Kortaro
authors: K
authors: Tanaka
authors: Susumu
authors: S
authors: Miyamoto
authors: Kazuo
authors: K
authors: Minematsu
authors: Masayasu
authors: M
authors: Matsumoto
authors: Yasushi
authors: Y
authors: Okada
authors: Motoki
authors: M
authors: Sato
authors: Norihiro
authors: N
authors: Suzuki
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012107:Research Design; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis