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Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Lancet neurology, 2021-04, Vol.20 (4), p.294-303
2021

Details

Autor(en) / Beteiligte
Titel
Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Ist Teil von
  • Lancet neurology, 2021-04, Vol.20 (4), p.294-303
Ort / Verlag
England: Elsevier Ltd
Erscheinungsjahr
2021
Link zum Volltext
Quelle
MEDLINE
Beschreibungen/Notizen
  • Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69–0·77) with a calibration slope of 0·94 (0·81–1·06) for the intracranial haemorrhage model and 0·63 (0·62–0·65) with a calibration slope of 0·97 (0·87–1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. British Heart Foundation and Stroke Association.
Sprache
Englisch
Identifikatoren
ISSN: 1474-4422
eISSN: 1474-4465
DOI: 10.1016/S1474-4422(21)00024-7
Titel-ID: cdi_proquest_miscellaneous_2503435205
Format
–
Schlagworte
Adult, Aged, Anticoagulants, Biomarkers, Care and treatment, Cohort analysis, Collaboration, Female, Fibrinolytic Agents - therapeutic use, Hemorrhage, Humans, Intracranial Hemorrhages - etiology, Ischemia, Ischemic Attack, Transient - complications, Ischemic Attack, Transient - diagnostic imaging, Ischemic Attack, Transient - drug therapy, Ischemic Stroke - complications, Ischemic Stroke - diagnostic imaging, Ischemic Stroke - drug therapy, Magnetic Resonance Imaging, Male, Medical research, Medicine, Experimental, Middle Aged, Patients, Prediction models, Recurrence, Regression analysis, Risk, Risk factors, Stroke, Stroke (Disease), Stroke patients, Transient ischemic attack

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