The Essen Stroke Risk Score in one-year follow-up acute ischemic stroke patients

Abstract

Background and purpose: We aimed to validate the usefulness of the Essen Stroke Risk Score (ESRS) to predict stroke recurrence in a hospital-based follow-up study.

Methods: We followed up 730 consecutive patients admitted to a neurological stroke unit in Berlin, Germany, with ischemic stroke (IS) or transient ischemic attack (TIA). The mean follow-up time was 13.4 months (SD 5.9). We calculated the time of event-free survival by Kaplan-Meier estimates.

Results: The cumulative rate of a recurrent stroke was 10.4% (76 of 730). The risk of a recurrent stroke was significantly higher in patients with an ESRS >2 (p = 0.01; log rank). The area under the curve (AUC) was 0.59. The risk of a vascular event (VE), defined as a fatal or nonfatal IS or myocardial infarction, was significantly higher in patients with an ESRS >2 (p = 0.003; log rank). The AUC was 0.58. Stratifying the data at exact 1-year follow-up, 9 of 185 (10.3%) patients with an ESRS ≤2 suffered a recurrent stroke, while 56 of 311 (18%) patients with an ESRS >2 did so (p < 0.02; χ(2)). Thirty-six of 196 (18.4%) patients with an ESRS ≤2 suffered a VE, while 156 of 353 (35.7%) patients with an ESRS >2 did so (p < 0.001; χ(2)).

Conclusions: The ESRS identifies groups of patients with TIA or IS who are at significantly increased risk for a recurrent stroke and cardiovascular event. Patients with a high ESRS require short-term follow-up and reevaluation of secondary prevention strategies.