IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke

Manuel Cappellari, Salvatore Mangiafico, Valentina Saia, Giovanni Pracucci, Sergio Nappini, Patrizia Nencini, Daniel Konda, Fabrizio Sallustio, Stefano Vallone, Andrea Zini, Sandra Bracco, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Antonio Pitrone, Francesco Grillo, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro MagoniEdoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Chiara Comelli, Enrica Duc, Alessio Comai, Enrica Franchini, Mirco Cosottini, Michelangelo Mancuso, Simone Peschillo, Manuela De Michele, Andrea Giorgianni, Maria Luisa Delodovici, Elvis Lafe, Maria F Denaro, Nicola Burdi, Saverio Internò, Nicola Cavasin, Adriana Critelli, Luigi Chiumarulo, Marco Petruzzellis, Marco Doddi, Antonio Carolei, William Auteri, Alfredo Petrone, Riccardo Padolecchia, Tiziana Tassinari, Marco Pavia, Paolo Invernizzi, Gianni Turcato, Stefano Forlivesi, Elisa Francesca Maria Ciceri, Bruno Bonetti, Domenico Inzitari, Danilo Toni

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.

AIMS: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.

METHODS: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set.

CONCLUSIONS: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.

Original languageEnglish
Pages (from-to)1747493019837756
JournalInternational Journal of Stroke
DOIs
Publication statusE-pub ahead of print - Mar 25 2019

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Thrombectomy
Nomograms
Registries
Stroke
ROC Curve
Area Under Curve
Logistic Models
Confidence Intervals
Therapeutics
Brain Ischemia
Cohort Studies
Population

Cite this

Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., ... Toni, D. (2019). IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. International Journal of Stroke, 1747493019837756. https://doi.org/10.1177/1747493019837756

IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. / Cappellari, Manuel; Mangiafico, Salvatore; Saia, Valentina; Pracucci, Giovanni; Nappini, Sergio; Nencini, Patrizia; Konda, Daniel; Sallustio, Fabrizio; Vallone, Stefano; Zini, Andrea; Bracco, Sandra; Tassi, Rossana; Bergui, Mauro; Cerrato, Paolo; Pitrone, Antonio; Grillo, Francesco; Saletti, Andrea; De Vito, Alessandro; Gasparotti, Roberto; Magoni, Mauro; Puglielli, Edoardo; Casalena, Alfonsina; Causin, Francesco; Baracchini, Claudio; Castellan, Lucio; Malfatto, Laura; Menozzi, Roberto; Scoditti, Umberto; Comelli, Chiara; Duc, Enrica; Comai, Alessio; Franchini, Enrica; Cosottini, Mirco; Mancuso, Michelangelo; Peschillo, Simone; De Michele, Manuela; Giorgianni, Andrea; Luisa Delodovici, Maria; Lafe, Elvis; Denaro, Maria F; Burdi, Nicola; Internò, Saverio; Cavasin, Nicola; Critelli, Adriana; Chiumarulo, Luigi; Petruzzellis, Marco; Doddi, Marco; Carolei, Antonio; Auteri, William; Petrone, Alfredo; Padolecchia, Riccardo; Tassinari, Tiziana; Pavia, Marco; Invernizzi, Paolo; Turcato, Gianni; Forlivesi, Stefano; Francesca Maria Ciceri, Elisa; Bonetti, Bruno; Inzitari, Domenico; Toni, Danilo.

In: International Journal of Stroke, 25.03.2019, p. 1747493019837756.

Research output: Contribution to journalArticle

Cappellari, M, Mangiafico, S, Saia, V, Pracucci, G, Nappini, S, Nencini, P, Konda, D, Sallustio, F, Vallone, S, Zini, A, Bracco, S, Tassi, R, Bergui, M, Cerrato, P, Pitrone, A, Grillo, F, Saletti, A, De Vito, A, Gasparotti, R, Magoni, M, Puglielli, E, Casalena, A, Causin, F, Baracchini, C, Castellan, L, Malfatto, L, Menozzi, R, Scoditti, U, Comelli, C, Duc, E, Comai, A, Franchini, E, Cosottini, M, Mancuso, M, Peschillo, S, De Michele, M, Giorgianni, A, Luisa Delodovici, M, Lafe, E, Denaro, MF, Burdi, N, Internò, S, Cavasin, N, Critelli, A, Chiumarulo, L, Petruzzellis, M, Doddi, M, Carolei, A, Auteri, W, Petrone, A, Padolecchia, R, Tassinari, T, Pavia, M, Invernizzi, P, Turcato, G, Forlivesi, S, Francesca Maria Ciceri, E, Bonetti, B, Inzitari, D & Toni, D 2019, 'IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke', International Journal of Stroke, pp. 1747493019837756. https://doi.org/10.1177/1747493019837756
Cappellari, Manuel ; Mangiafico, Salvatore ; Saia, Valentina ; Pracucci, Giovanni ; Nappini, Sergio ; Nencini, Patrizia ; Konda, Daniel ; Sallustio, Fabrizio ; Vallone, Stefano ; Zini, Andrea ; Bracco, Sandra ; Tassi, Rossana ; Bergui, Mauro ; Cerrato, Paolo ; Pitrone, Antonio ; Grillo, Francesco ; Saletti, Andrea ; De Vito, Alessandro ; Gasparotti, Roberto ; Magoni, Mauro ; Puglielli, Edoardo ; Casalena, Alfonsina ; Causin, Francesco ; Baracchini, Claudio ; Castellan, Lucio ; Malfatto, Laura ; Menozzi, Roberto ; Scoditti, Umberto ; Comelli, Chiara ; Duc, Enrica ; Comai, Alessio ; Franchini, Enrica ; Cosottini, Mirco ; Mancuso, Michelangelo ; Peschillo, Simone ; De Michele, Manuela ; Giorgianni, Andrea ; Luisa Delodovici, Maria ; Lafe, Elvis ; Denaro, Maria F ; Burdi, Nicola ; Internò, Saverio ; Cavasin, Nicola ; Critelli, Adriana ; Chiumarulo, Luigi ; Petruzzellis, Marco ; Doddi, Marco ; Carolei, Antonio ; Auteri, William ; Petrone, Alfredo ; Padolecchia, Riccardo ; Tassinari, Tiziana ; Pavia, Marco ; Invernizzi, Paolo ; Turcato, Gianni ; Forlivesi, Stefano ; Francesca Maria Ciceri, Elisa ; Bonetti, Bruno ; Inzitari, Domenico ; Toni, Danilo. / IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. In: International Journal of Stroke. 2019 ; pp. 1747493019837756.
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title = "IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke",
abstract = "BACKGROUND: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.AIMS: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.METHODS: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).RESULTS: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95{\%} confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95{\%} CI: 0.786-0.854) in the test set.CONCLUSIONS: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.",
author = "Manuel Cappellari and Salvatore Mangiafico and Valentina Saia and Giovanni Pracucci and Sergio Nappini and Patrizia Nencini and Daniel Konda and Fabrizio Sallustio and Stefano Vallone and Andrea Zini and Sandra Bracco and Rossana Tassi and Mauro Bergui and Paolo Cerrato and Antonio Pitrone and Francesco Grillo and Andrea Saletti and {De Vito}, Alessandro and Roberto Gasparotti and Mauro Magoni and Edoardo Puglielli and Alfonsina Casalena and Francesco Causin and Claudio Baracchini and Lucio Castellan and Laura Malfatto and Roberto Menozzi and Umberto Scoditti and Chiara Comelli and Enrica Duc and Alessio Comai and Enrica Franchini and Mirco Cosottini and Michelangelo Mancuso and Simone Peschillo and {De Michele}, Manuela and Andrea Giorgianni and {Luisa Delodovici}, Maria and Elvis Lafe and Denaro, {Maria F} and Nicola Burdi and Saverio Intern{\`o} and Nicola Cavasin and Adriana Critelli and Luigi Chiumarulo and Marco Petruzzellis and Marco Doddi and Antonio Carolei and William Auteri and Alfredo Petrone and Riccardo Padolecchia and Tiziana Tassinari and Marco Pavia and Paolo Invernizzi and Gianni Turcato and Stefano Forlivesi and {Francesca Maria Ciceri}, Elisa and Bruno Bonetti and Domenico Inzitari and Danilo Toni",
year = "2019",
month = "3",
day = "25",
doi = "10.1177/1747493019837756",
language = "English",
pages = "1747493019837756",
journal = "International Journal of Stroke",
issn = "1747-4930",
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TY - JOUR

T1 - IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke

AU - Cappellari, Manuel

AU - Mangiafico, Salvatore

AU - Saia, Valentina

AU - Pracucci, Giovanni

AU - Nappini, Sergio

AU - Nencini, Patrizia

AU - Konda, Daniel

AU - Sallustio, Fabrizio

AU - Vallone, Stefano

AU - Zini, Andrea

AU - Bracco, Sandra

AU - Tassi, Rossana

AU - Bergui, Mauro

AU - Cerrato, Paolo

AU - Pitrone, Antonio

AU - Grillo, Francesco

AU - Saletti, Andrea

AU - De Vito, Alessandro

AU - Gasparotti, Roberto

AU - Magoni, Mauro

AU - Puglielli, Edoardo

AU - Casalena, Alfonsina

AU - Causin, Francesco

AU - Baracchini, Claudio

AU - Castellan, Lucio

AU - Malfatto, Laura

AU - Menozzi, Roberto

AU - Scoditti, Umberto

AU - Comelli, Chiara

AU - Duc, Enrica

AU - Comai, Alessio

AU - Franchini, Enrica

AU - Cosottini, Mirco

AU - Mancuso, Michelangelo

AU - Peschillo, Simone

AU - De Michele, Manuela

AU - Giorgianni, Andrea

AU - Luisa Delodovici, Maria

AU - Lafe, Elvis

AU - Denaro, Maria F

AU - Burdi, Nicola

AU - Internò, Saverio

AU - Cavasin, Nicola

AU - Critelli, Adriana

AU - Chiumarulo, Luigi

AU - Petruzzellis, Marco

AU - Doddi, Marco

AU - Carolei, Antonio

AU - Auteri, William

AU - Petrone, Alfredo

AU - Padolecchia, Riccardo

AU - Tassinari, Tiziana

AU - Pavia, Marco

AU - Invernizzi, Paolo

AU - Turcato, Gianni

AU - Forlivesi, Stefano

AU - Francesca Maria Ciceri, Elisa

AU - Bonetti, Bruno

AU - Inzitari, Domenico

AU - Toni, Danilo

PY - 2019/3/25

Y1 - 2019/3/25

N2 - BACKGROUND: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.AIMS: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.METHODS: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).RESULTS: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set.CONCLUSIONS: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.

AB - BACKGROUND: The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.AIMS: We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.METHODS: We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).RESULTS: A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set.CONCLUSIONS: The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.

U2 - 10.1177/1747493019837756

DO - 10.1177/1747493019837756

M3 - Article

C2 - 30907302

SP - 1747493019837756

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

ER -