Prediction of vascular risk after stroke - protocol and pilot data of the Prospective Cohort with Incident Stroke
Thomas G Liman1, Vera Zietemann, Silke Wiedmann
1Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany. thomas.liman@charite.de
Insights
This study develops and validates new prediction models for vascular events after stroke. The advanced model, incorporating biomarkers and imaging, shows improved prediction of stroke, myocardial infarction, and vascular death within three years.
Area of Science:
- Cardiovascular Research
- Neurology
- Biostatistics
Background:
- Stroke survivors face a significantly elevated long-term risk of vascular disease.
- Existing prognostic models for predicting subsequent vascular events after stroke have shown limited predictive accuracy in recent validation studies.
Purpose of the Study:
- To develop and externally validate prediction models of varying complexity for a combined vascular endpoint (stroke, myocardial infarction, vascular death) at three years post-first-ever stroke.
- To compare the performance of basic and advanced prediction models.
Main Methods:
- A prospective observational hospital-based cohort study of patients following their first-ever stroke.
- Development of a basic clinical score and an advanced score incorporating biomarkers and vascular imaging.
- Model comparison using discrimination and calibration; assessment of clinical utility via reclassification tables; and external validation.
Main Results:
- The primary outcome is the composite of stroke, myocardial infarction, and vascular death within three years.
- Individual components of the composite endpoint will be analyzed separately.
- Patterns and timing of risk transitions between vascular events and stroke subtypes will be investigated.
Conclusions:
- New prediction models are developed for vascular events post-stroke.
- External validation will assess the generalizability of these models.
- The study aims to improve risk stratification for secondary vascular prevention.
Rationale:
Long-term risk of vascular disease is substantially increased after stroke with several models proposed to predict subsequent stroke and other vascular events after an index event. However, recent validation studies demonstrate limited predictive properties of available prognostic models.
Aims:
We aim to determine prediction models of different complexity for the combined vascular end-point of stroke, myocardial infarction, and vascular death at three-years after first-ever stroke. An independent external validation of the developed models will be performed.
Design:
Prospective observational hospital-based cohort study of patients after first-ever stroke.
Methods:
The new predictive models will be developed using the following steps: (1) Development of a basic score based on clinical history data (e.g. hypertension, myocardial infarction, and atrial fibrillation); (2) Development of an advanced score including additional factors such as blood-based biomarkers and results of vascular imaging; (3) Comparing the models fit using different methods (discrimination, calibration); (4) Assessment of clinical utility of an advanced score using methods based on reclassification tables (e.g. net reclassification improvement, integrated discrimination improvement, decision curve analysis); and (5) Investigation of external validity.
Outcomes:
Primary outcome is a combined vascular end-point composed of stroke, myocardial infarction, and vascular death at three-years after stroke. Furthermore, each component of the composite end-point will be investigated individually and the patterns and time points of risk transitions between vascular end-points and stroke sub-types will be determined.
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