THRIVE score predicts outcomes with a third-generation endovascular stroke treatment device in the TREVO-2 trial.
OBJECTIVE
Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device).


METHODS
We used data from the TREVO-2 trial to validate the Totaled Health Risks in Vascular Events (THRIVE) score in patients receiving treatment with a third-generation endovascular stroke treatment device and to compare THRIVE to other predictive scores. We used logistic regression to model outcomes and compared score performance with receiver operating characteristic curve analysis.


RESULTS
In the TREVO-2 trial, the THRIVE score strongly predicts clinical outcome and mortality. The relationship between THRIVE score and outcome is not influenced by either success of recanalization or the type of device used (Trevo versus Merci). The superiority of the Trevo device to the Merci device is evident particularly among patients with a low-to-moderate THRIVE score (0-5; 53.8% good outcome with Trevo versus 27.5% good outcome with Merci). In receiver operating characteristic curve analysis, the THRIVE score was comparable or superior to several other outcome prediction scores (HIAT, HIAT-2, SPAN-100, and iScore).


CONCLUSIONS
The THRIVE score strongly predicts clinical outcome and mortality in the TREVO-2 trial. Taken together with THRIVE validation data from patients receiving intravenous tissue-type plasminogen activator or no acute treatment, the THRIVE score has broad predictive power in patients with acute ischemic stroke, which is likely because THRIVE reflects a set of strong nonmodifiable predictors of stroke outcome. A free Web calculator for the THRIVE score is available at http://www.thrivescore.org.
From the Department of Neuroscience, Kaiser Permanente, Redwood City, CA (A.C.F.); Department of Clinical Research, Prospect Analytical, San Jose, CA (B.X.); Departments of Neurology, Neurosurgery, and Radiology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.G., R.G.N.); Department of Neurology, Oregon Health and Science University, Portland, OR (H.L.L.); Department of Neurology, UPMC Stroke Center, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Neurology, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA (G.W.A.); Department of Neurology, UCLA Stroke Center, University of California, Los Angeles, CA (D.S.L.); Department of Neurology, University of Southern California, Los Angeles, CA (N.S.); and Department of Neurology, University of California, San Francisco, CA (W.S.S.).
Alexander C
AC
Flint
Bin
B
Xiang
Rishi
R
Gupta
Raul G
RG
Nogueira
Helmi L
HL
Lutsep
Tudor G
TG
Jovin
Gregory W
GW
Albers
David S
DS
Liebeskind
Nerses
N
Sanossian
Wade S
WS
Smith
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
cerebral hemorrhage; forecasting; outcome assessment; stroke