IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke: International Journal of Stroke

M. Cappellari, S. Mangiafico, V. Saia, G. Pracucci, S. Nappini, P. Nencini, D. Konda, F. Sallustio, S. Vallone, A. Zini, S. Bracco, R. Tassi, M. Bergui, P. Cerrato, A. Pitrone, F. Grillo, A. Saletti, A. De Vito, R. Gasparotti, M. MagoniE. Puglielli, A. Casalena, F. Causin, C. Baracchini, L. Castellan, L. Malfatto, R. Menozzi, U. Scoditti, C. Comelli, E. Duc, A. Comai, E. Franchini, M. Cosottini, M. Mancuso, S. Peschillo, M. De Michele, A. Giorgianni, M. Luisa Delodovici, E. Lafe, M.F. Denaro, N. Burdi, S. Internò, N. Cavasin, A. Critelli, L. Chiumarulo, M. Petruzzellis, M. Doddi, A. Carolei, W. Auteri, A. Petrone, R. Padolecchia, T. Tassinari, M. Pavia, P. Invernizzi, G. Turcato, S. Forlivesi, E. Francesca Maria Ciceri, B. Bonetti, D. Inzitari, D. Toni

Research output: Contribution to journalArticlepeer-review


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)412-420
Number of pages9
JournalInt. J. Stroke
Issue number4
Publication statusPublished - Jun 1 2020


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