| Objective To improve Essen Stroke Risk Score(ESRS)into a new stroke risk scale,so as to improve the efficiency of ESRS in predicating the recurrence of ischemic stroke in one year after Transient Ischemic Attack(TIA),Ischemic Minor Stroke(IMS);to have more reasonable risk stratification on TIA/IMS patients and optimize the treatment and to reduce the recurrence rate of ischemic stroke.Methods TIA,IMS patients from August 30,2014 to May 31,2015 that had been hospitalized in the unit wards of neurology and stroke department in General Hospital of Ningxia Medical University were included in the study.Clinical information and imaging materials of all patients were collected and used to calculate Essen scores and 3 kinds of improved Essen scores.On the basis of ESRS,there were three improvement methods: improvement 1: the risk factor of past disease history of TIA/ischemic stroke was assigned 2 points,with the total scores of 10 points;improvement 2: ESRS combining cervical artery CT angiography,extracraninal arterial stenosis ≥ 50%=1 point,extracraninal arterial stenosis < 50%=0 point,with the total scores of 10 points;Improvement 3: ESRS was combined with CTA and the risk factor of past disease history of TIA/ischemic stroke was changed to 2 points,with the total scores of 11 points.The end events of all patients were followed up,including ischemic stroke recurrence and death.ROS curve was adopted to evaluate the accuracy of improved ESRS predicting end events risk in one year after TIS/IMS.Results 1.Medical materials of 290 patients with TIA,IMS were collected,25 cases lost to follow-up and 265 cases included in the study.In one year,39 cases(14.7%)got end events and 4 died.2.Among 122 cases with disease history of TIA/ischemic stroke,29 cases(23.8%)got end events;statistical analysis was conducted on disease history of TIA/ischemic stroke and the occurrence of end events,χ2=14.765,P=0.000;3.Among 103 cases with extracraninal arterial stenosis ≥50%,23 cases(22.3%)got end events;statistical analysis was conducted on cervical vessel stenosis and the occurrence of end events,χ2=7.781,P=0.005;4.ROC area under the curve of ESRS predicating end events of TIA/ IMS patients in one year was 0.708(95%CI:0.626-0.791,P<0.05);ROC area under the curve of improvement 1 predicating end events of TIA/ IMS patients in one year was 0.724(95%CI:0.646-0.802,P< 0.05);ROC area under the curve of improvement 2 predicating end events of TIA/ IMS patients in one year was 0.730(95%CI: 0.650-0.810,P< 0.055);When the scores of three scoring methods were all 2.5 points,the sum of its sensitivity and specificity was the biggest.ROC area under the curve of improvement 3 predicating end events of TIA/ IMS patients in one year was 0.747(95%CI: 0.677-0.818,P< 0.05);when the score was 3.5 points,the sum of its sensitivity and specificity was the biggest.Conclusions 1.ESRS and 3 kinds of improved ESRS all can accurately predicate the recurrence of ischemic stroke in one year after TIA/IMS.The recurrence rate of high risk group was significantly higher than that of low risk group.The highest predictive performance of improvement 3.2.Diabetes,disease history of TIA/ischemic stroke and extracraninal arterial stenosis≥ 50% are risk factors of the recurrence of ischemic stroke in one year after TIA/IMS. |
