Related Experiment Video
Updated: Mar 16, 2026

Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source
George Ntaios1, Konstantinos Vemmos2, Gregory Y H Lip2
1From the Department of Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Greece (G.N., G.A., K.M., V.P.); Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Greece (K.V., E.K., E.M., A.V.); University of Birmingham Institute of Cardiovascular Sciences, City Hospital, United Kingdom (G.Y.H.L.); Stroke Unit, Department of Neurology, Hospital del Mar, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona, Spain (A.R.-C., E.C.-G., E.G.-S.); Stroke Unit, University of Perugia, Italy (V.A., V.C., M.P.); Department of Neurology and Stroke Center, La Paz University Hospital - Autónoma University of Madrid, IdiPAZ Health Research Institute, Spain (E.D.-T., B.F., J.P.L.); Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico (A.A.); Department of Neurology, Institute for Neurological Research, FLENI, Buenos Aires, Argentina (S.F.A., M.A.H., L.P., M.G.-S.); Department of Neurology, San Paolo Hospital, Savona, Italy (F.B.); Vascular Neurology Section, Stroke Center, Hospital General Universitario Gregorio Marañón, IiSGM Health Research Institute, Universidad Complutense de Madrid, Spain (B.C.C., A.M.I.M; A.G.P., A.G.-N.); Department of Neurology, Helsinki university Central Hospital and University of Helsinki, Finland (J.P., T.T.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.); Department of Neurosciences, Hospital Dr. Rafael A. Calderón Guardia, CCSS, University of Costa Rica (M.A.B.); and Stroke Service, Department of Neurosciences, Leeds Teaching Hospitals NHS Trust and Medical School, University of Leeds, United Kingdom (V.P.). gntaios@med.uth.gr.
Background And Purpose:
The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS.
Methods:
We pooled data sets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. Cox regression analyses were performed to investigate if prestroke CHADS2 and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) scores were independently associated with the risk of ischemic stroke/TIA recurrence or death. The Kaplan-Meier product limit method was used to estimate the cumulative probability of ischemic stroke/TIA recurrence and death in different strata of the CHADS2 and CHA2DS2-VASc scores.
Results:
One hundred fifty-nine (5.6% per year) ischemic stroke/TIA recurrences and 148 (5.2% per year) deaths occurred in 1095 patients (median age, 68 years) followed-up for a median of 31 months. Compared with CHADS2 score 0, patients with CHADS2 score 1 and CHADS2 score >1 had higher risk of ischemic stroke/TIA recurrence (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.41-4.00 and HR, 2.72; 95% CI, 1.68-4.40, respectively) and death (HR, 3.58; 95% CI, 1.80-7.12, and HR, 5.45; 95% CI, 2.86-10.40, respectively). Compared with low-risk CHA2DS2-VASc score, patients with high-risk CHA2DS2-VASc score had higher risk of ischemic stroke/TIA recurrence (HR, 3.35; 95% CI, 1.94-5.80) and death (HR, 13.0; 95% CI, 4.7-35.4).
Conclusions:
The risk of recurrent ischemic stroke/TIA and death in ESUS is reliably stratified by CHADS2 and CHA2DS2-VASc scores. Compared with the low-risk group, patients in the high-risk CHA2DS2-VASc group have much higher risk of ischemic stroke recurrence/TIA and death, approximately 3-fold and 13-fold, respectively.
Related Concept Videos
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Actuarial Approach
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
Assumptions of Survival Analysis
Heart Failure IV: Classification and Diagnostic Evaluation
