Essen score in the prediction of cerebrovascular events compared with cardiovascular events after ischaemic stroke or transient ischaemic attack:a nationwide registry analysis

BACKGROUND The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence.Recent study showed it could also predict myocardial infarction(MI).This study aimed to compare the Essen score’s ability to predict cerebrovascular events with compared cardiovascular events.METHODS We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry.One-year cumulative event rates of combined vascular events(a composite of MI,stroke recurrence or vascular death)and cardiac events(a composite of MI,heart failure or cardiac death)was estimated using the Kaplan-Meier met-hod.The predictive value of the Essen score was assessed with C-statistics.In multivariate Cox regression analyses,we assessed whether Essen score,etiological subtype and imaging parameters were associated with outcomes.RESULTS Of 13,012 patients were included,the cumulative one-year event rates were 10.03%for combined vascular events and 0.77%for cardiac events,respectively.Compared with those with an Essen score<3,patients with an Essen score≥3 were more likely to have a subsequent combined vascular event[hazard ratio(HR)=1.39,95%CI:1.24−1.55]and cardiac events(HR=2.30,95%CI:1.53−3.44).The score tended to be more predictive of the risk of MI(C-statistic=0.63,95%CI:0.55−0.71)and cardiac events(C-statistic=0.62,95%CI:0.56−0.67)than stroke recurrence(C-statistic=0.55,95%CI:0.54−0.57)and combined vascular events(C-statistic=0.56,95%CI:0.54−0.57).In multivariable analysis after adjusted Essen score,patients with multiple acute in-farctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events.While the cardioembolism subtype was associated with an increased risk of cardiac events.CONCLUSIONS The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events.Moreover,future predictive tools should take brain imaging findings and cause of stroke into consideration.

Prognostic value of admission hyperglycemia on outcomes of thrombolysis in ischemic stroke patients with or without diabetes

Thrombolytic therapy within 4.5 h from symptom onset is a recognized effective and standard therapy for acute ischemic stroke(AIS),but some patients still have a poor clinical outcome.The evaluation and control of predictors for AIS poor clinical outcomes is integral to achieving optimal treatments,but the prognostic value of admission blood glucose(ABG)for this purpose is unclear and still under debate.ABG evaluated in patients without diabetes mellitus(DM)often suggests acute stress hyperglycemia,while ABG may have a close relationship with long-term blood glucose control in patients with DM.However,in most studies about the influence of ABG on the prognosis of recombinant tissue-type plasminogen activator(rtPA)therapy after AIS,patients were not classified into those with and without DM.The present study was designed to investigate the prognostic value of ABG for clinical outcomes of AIS after thrombolysis according to DM status in a Chinese population.