Evaluation Of Esrs And SPI-Ⅱ Scales For Short-term Prognosi Of Minor Stroke And TIA

Objective: It is important to evaluate recurrent risk for patients withstroke immediately after onset. Then the optimal therapy would be givenpromptly to prevent from recurring and improve clinical outcome. As a crucialcause of disability and mortality, recurrent stroke should be preventedappropriately. Evaluation of patients' recurrent risk after minor stroke cou物色ld raise awareness and provide some guidance for prevention strategy. Ourstudy aimed to evaluate the short-term recurrent risk of patients withminor stroke and transient ischemic attack (TIA) using ESSEN StrokeRisk Scale (ESRS) and Stroke Prognostic Instrument-II (SPI-Ⅱ) scaleand then investigated a prognostic method.Patients: Between March2009and October2011, patients with minorstroke or transient ischemic attack (TIA) diagnosed in neurology departmentof the3rdhospital of Hebei Medical University were enrolled. The generalcharacteristics and prior medical history were recorded exactly. TIA wasdistinguished from acute stroke by brain Diffusion Weighted Imaging (DWI).Minor stroke was defined by graded no more than3points by NationalInstitute of Health stroke scale (NIHSS).Methods:From March2009to October2011, we prospectively studied patientswith acute stroke or TIA in the department of neurology,3rdhospital of HebeiMedical University and part of the records came from CHANCE database.The enrolled patients randomly accepted aspirin (150～300mg/d) and/orclopidogrel (75mg/d,initial dose300mg) within24hours after ischemicsyndrome in double-blind method. All the patients were diagnosed by medicalhistory, clinical features and imaging Standardized case report forms includeddemographic information, risk factors, comorbidity, stroke severity on the National Institutes of Health Stroke Scale (NIHSS) and serum biochemicalindicators were monitored.Diagnostic criteria: TIA is defined as a transient episode of neurologicaldysfunction caused by local brain, spinal cord, or retinal ischemia, withoutacute cerebral infarction. Otherwise, epilepsy, hysteria and absence seizurewere differentiated. Acute ischemic infraction proved by brain DWI withneurological dysfunction score≤3on NIHSS is considered as minor stroke.Patients consistent with the inclusion criteria above were scored by ESRS andSPI-II scale respectively. Recurrent cardio-and cerebro-vascular ischemicevents were followed up within90days. The neurological dysfunctiondeteriorated by4points on NIHSS was also defined recurrence. Calculatedaccumulative survival rate at each point of recurrent events and then make thecurve of accumulative survival rate. According to the scores evaluated byESRS and SPI-II scale, receiver operating characteristic curve (ROC) wascompleted to evaluate predictive value between ESRS and SPI-II scaleroundly.All the available data were detected by normality test. Enumeration datawere calculated as constituent ratio while measurement data as mean±standard deviation (SD; x±s) or median (interquartile range, IQR).Independent proportions were compared using either the chi-square (χ2) orFisher's exact test, as appropriate. Analyses were performed with SPSSstatistical package, Version19.0. P＜0.05was considered as significant.Results:1.167patients (mean age:61.1±10.8years) with minor stroke or TIAwere enrolled. Male patients who took up71.3%of all patients had a higherproportion in smoking than the female.66.5%in the patients enrolled sufferedminor stroke and a larger proportion in prior cerebral infractions was observedin patients with minor stroke than TIA.2. The recurrent rate of ischemic events within90days was12.57%while7.78%in the first week. The recurrent rate of patients with TIA was23.2%which was significant higher than the patients with minor stroke (7.2%). The recurrent rate was as high as8%in the fist week, taking up more than half ofthe recurrent events during follow-up. The cumulative survival rates afteronset were92.22%,90.42%,88.02%,87.42%at the7th,30th,60th,90thdaysrespectively. The highest recurrent risk was observed at the acute phase afteronset and decreased along with the pathogenesis. What is mentioned,therewas1patient suffered cerebral hemorrhage during follow up.3.21patients who suffered recurrent ischemic events were scored byESSEN and SPI-II scales and17(81%) patients were stratified at high riskgroup. The curve of ROC was drawn for each model plotting specificityagainst sensitivity. The curve was shown in Figure2. The area under ROC was0.677(95%CI:0.557～0.797) for ESSEN score,0.553(95%CI:0.413～0.694)for SPI-II score.Conclusion:1. The recurrent ischemic events were mainly occurred at acute phaseafter minor stroke or TIA and the recurrent risk was the highest in the firstweek. Along with the pathogenesis, the recurrent risk of minor strokedecreased gradually.2. At preliminary diagnosis, ESRS and SPI-Ⅱ scales both haveshort-term prognostic value for patients of minor stroke or TIA. Theshort-term prognostic value of ESRS scale was better than SPI-Ⅱ scale andwas more likely to be used in high-risk screening.