A Risk Score Including Carotid Plaque Inflammation and Stenosis Severity Improves Identification of Recurrent Stroke
| Autor: | Shelagh B. Coutts, Gillian Horgan, Eoin C. Kavanagh, Vijay Sharma, John McCabe, Michael Marnane, Shane Foley, Sean Murphy, David J. Williams, Martin O'Connell, Ciaran McDonnell, Pol Camps-Renom, Jean-Claude Baron, Simon Cronin, Joseph Harbison, Nicola Giannotti, Joan Martí-Fàbregas, Eamon Dolan, Jonathan P. McNulty, Alejandro Fernández-León, Peter J. Kelly, Raquel Delgado-Mederos, Mary Barry |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty hypertension positron emission tomography medicine.medical_treatment Carotid endarterectomy Risk Assessment Severity of Illness Index law.invention Randomized controlled trial law Fluorodeoxyglucose F18 Diabetes mellitus Internal medicine medicine Humans Carotid Stenosis Prospective Studies Endarterectomy Aged Advanced and Specialized Nursing Inflammation endarterectomy Framingham Risk Score medicine.diagnostic_test business.industry Middle Aged medicine.disease Plaque Atherosclerotic Stroke Stenosis inflammation Positron emission tomography Positron-Emission Tomography diabetes mellitus Cardiology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Plaque inflammation |
| Zdroj: | STROKE r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 1524-4628 0039-2499 |
| Popis: | Background and Purpose— In randomized trials of symptomatic carotid endarterectomy, only modest benefit occurred in patients with moderate stenosis and important subgroups experienced no benefit. Carotid plaque 18 F-fluorodeoxyglucose uptake on positron emission tomography, reflecting inflammation, independently predicts recurrent stroke. We investigated if a risk score combining stenosis and plaque 18 F-fluorodeoxyglucose would improve the identification of early recurrent stroke. Methods— We derived the score in a prospective cohort study of recent (18 F-fluorodeoxyglucose standardized uptake values (SUV max max 2–2.99 g/mL, 1 point; SUV max 3–3.99 g/mL, 2 points; SUV max ≥4 g/mL, 3 points) and stenosis ( Results— In the derivation cohort (109 patients), recurrent stroke risk increased with increasing SCAIL score ( P =0.002, C statistic 0.71 [95% CI, 0.56–0.86]). The adjusted (age, sex, smoking, hypertension, diabetes mellitus, antiplatelets, and statins) hazard ratio per 1-point SCAIL increase was 2.4 (95% CI, 1.2–4.5, P =0.01). Findings were confirmed in the validation cohort (87 patients, adjusted hazard ratio, 2.9 [95% CI, 1.9–5], P P =0.005). Compared with stenosis severity (C statistic, 0.63 [95% CI, 0.46–0.80]), prediction of post-positron emission tomography stroke recurrence was improved with the SCAIL score (C statistic, 0.82 [95% CI, 0.66–0.97], P =0.04). Findings were confirmed in mild or moderate stenosis (adjusted hazard ratio, 2.74 [95% CI, 1.39–5.39], P =0.004). Conclusions— The SCAIL score improved the identification of early recurrent stroke. Randomized trials are needed to test if a combined stenosis-inflammation strategy improves selection for carotid revascularization where benefit is currently uncertain. |
| Databáze: | OpenAIRE |
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