Development and Evaluation of the Model for Predicting 10-Year Cardiovascular Mortality in Patients with Ischemic...

Currently, evidence regarding risk factors for 10-year cardiovascular mortality after ischemic stroke remains limited. This study aimed to develop and evaluate a robust predictive model for 10-year cardiovascular mortality in ischemic stroke patients.

The predictive model was derived from the Acute Ischemic Stroke Intervention and Secondary Prevention Registry (AISISPR), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. We identified 10-year cardiovascular mortality risk factors by analyzing comprehensive clinical data, including (1) medical histories, (2) demographic characteristics, (3) laboratory parameters, and (4) imaging findings. The area under the receiver operating characteristic curve (AUROC) and the calibration curve were used to assess model discrimination and calibration.

A total of 4,574 participants were included, with a mean age of 64.3 years. The model showed excellent discrimination for 10-year cardiovascular mortality across derivation (AUROC = 0.839; 95% CI: 0.822-0.856), validation (AUROC = 0.841; 95% CI: 0.820-0.862) cohort. Patients with carotid artery stenosis had a 19% higher cardiovascular mortality risk than those without stenosis (hazard ratio [HR] 1.19, 95% CI 1.01-1.40). Previous stroke was associated with a 44% increased risk of mortality (HR 1.44, 95% CI 1.24-1.68). In addition, among the subtypes of ischemic stroke, the large-artery atherosclerotic subtype and the modified Rankin Scale (mRS) score at discharge significantly increased the risk of cardiovascular mortality, while the use of standardized secondary prevention medications reduced the risk of cardiovascular mortality.

The current prediction model demonstrates accurate prognostic performance for 10-year cardiovascular mortality following ischemic stroke. However, further validation in diverse populations and larger cohorts is warranted.