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Evaluation of Risk Scores as Predictive Tools for Stroke in Patients with Retinal Artery Occlusion: A Danish
Marie Ørskov1,2, Henrik Vorum3, Torben Bjerregaard Larsen1,2
1Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
Insights
This study found that the CHA₂DS₂-VASc and ESSEN Stroke Risk scores can help stratify stroke risk in patients with retinal artery occlusion. However, their ability to predict stroke is limited due to poor discrimination.
Area of Science:
- Ophthalmology
- Neurology
- Cardiology
Background:
- Retinal artery occlusion (RAO) is a serious condition that can lead to stroke.
- Accurate risk stratification is crucial for managing patients with RAO.
- Contemporary stroke risk models need evaluation in the context of RAO.
Purpose of the Study:
- To investigate the 1-year risk of stroke in patients diagnosed with retinal artery occlusion.
- To evaluate the predictive and discriminating capabilities of the CHA₂DS₂-VASc and ESSEN Stroke Risk scores for embolic stroke in this population.
Main Methods:
- A Danish nationwide register-based cohort study of 7,906 patients with RAO (1995-2018).
- Stratification of patients based on CHA₂DS₂-VASc and ESSEN Stroke Risk scores.
- Analysis using Cox proportional hazards model, C-statistics, Brier score, and index of prediction accuracy.
Main Results:
- Stroke event rates increased with higher scores for both CHA₂DS₂-VASc and ESSEN Stroke Risk scores.
- Statistically significant differences in stroke risk were observed for CHA₂DS₂-VASc scores ≥2 and all ESSEN scores compared to a score of 0.
- C-statistics indicated moderate discrimination (61% for CHA₂DS₂-VASc, 62% for ESSEN).
Conclusions:
- The CHA₂DS₂-VASc and ESSEN Stroke Risk scores are applicable for stroke risk stratification in RAO patients.
- The predictive discrimination of these scores for stroke in RAO patients is limited, primarily due to low specificity.
Abstract:
Purpose We investigated the 1-year risk of stroke in patients with retinal artery occlusion and evaluated the predictive and discriminating abilities of contemporary risk stratification models for embolic stroke. Methods This register-based cohort study included 7,906 patients with retinal artery occlusion from Danish nationwide patient registries between 1995 and 2018. The study population was stratified according to the number of points obtained in the stroke risk scores: the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score. The 1-year risk of stroke within strata was evaluated and compared using the cox proportional hazards model. Furthermore, the discrimination of the risk scores as predictive tools for stroke risk assessment was investigated using C-statistics, Brier score, and the index of prediction accuracy. Results The stroke event rate in patients with retinal artery occlusion increased as the score increased for both risk scores, ranging from 3.62 (95% confidence interval [CI]: 2.46-5.31) per 100 person-years to 13.25 (95% CI: 11.78--14.89) per 100-person-years for increasing levels of the CHA 2 DS 2 -VASc score and from 3.97 (95% CI: 2.97-5.32) per 100 person-years to 16.43 (95% CI: 14.01-19.27) per 100 person-years for increasing levels of the ESSEN Stroke Risk score. Using a risk score of 0 as a reference, the difference was statistically significant for retinal artery occlusion patients with a CHA 2 DS 2 -VASc score of 2 or above and for all levels of the ESSEN Stroke Risk score. The C-statistics for the risk scores was 61% (95% CI: 58%-63%) and 62% (95% CI: 59-64%) for the CHA 2 DS 2 -VASc score and ESSEN Stroke Risk score, respectively. Conclusion The results suggested that the use of the CHA 2 DS 2 -VASc score and the ESSEN Stroke Risk score was applicable for risk stratification of stroke in patients with retinal artery occlusion, but discrimination was poor due to low specificity.
