The Correlation Of The Essen Stroke Risk Score And Stroke In Progression Or Early Recurrence In Patients With Acute Non-Cardioembolic Ischemic Stroke

Objects:To identify the risk factors of early stroke progression or recurrence in patients with acute non cardiac ischemic stroke.To explore the relationship between ESSEN risk factor score and the early stroke progression or recurrence of non cardiac ischemic stroke.Methods:We performed preliminary analysis of metaphase data recorded in the acute phase of stroke patients enrolled in the Clopidogrel Loading Dosage to Treat Acute Ischemic Stroke in China (CLASS-CHINA).Acute non-cardioembolic ischemic stroke in progression or early recurrence was diagnosed when there was an increase more than 2 points from baseline to the 7th day evaluation or from transient neurological improvement to secondary progression in the National Institutes of Health Stroke Scale. The ESRS was calculated according to history and discharge diagnosis. Prognosis outcome was evaluated by functional disability scales (Barthel Index, BI; modified Rankin Scale, mRS) which was performed via telephone or revisit in hospital at off-hospital or within 28 days and then 90 days. Death and dependency was diagnosed as the mRS≥3 points within 90 days. For statistical data analysis, we used the SPSS program version 13.0.Results:280 patients were included in the study. Progressive or early recurrent stroke occurred in 41 patients (14.6%). The higher NIHSS Score (Z=-2.28, P=0.02) and mRS (Z=-2.02, P=0.04) and lower BI (t=-2.37, P=0.02) on baseline and lower statin therapy (x2=4.92, P=0.02) were significantly associated with stroke in progression or recurrence in the univariate analyses. The lower BI on baseline (OR 0.981,95% CI, 0.967～0.995, P=0.008) and no statin therapy (OR 4. 629,95% CI,1.425～15.040, P=0.011) were the only factors independently associated with stroke in progression or early recurrence in the final logistic model. There are no difference in ESSEN stroke risk score between the two groups (Z=-0.30, P=0.77). And patients with different level of Essen Stroke Risk Score (<3,3-6) didn't significantly influence the progressive or early recurrent stroke (χ2=0.02,P=0.90). After 90 days,255 patients finished clinic follow-up, with 25 cases lost or in doubt (8.9%). Patients in the progressive or early recurrent group showed a significantly worse prognosis than those in the immediately stabilized group (BI, Z=-4.53, P=0.00; MRS, Z=-5.13, P=0.00). And the death and dependency rate was significantly higher (χ2=29.14,P=0.00).Conclusions:1) The Essen Stroke Risk Score, so far, has no predictive value in progression or early recurrence of acute non-cardioembolic stroke.2) Statin therapy can prevent the progression or early recurrence of acute non- cardioembolic ischemic stroke.3) The lower BI on baseline is independent risk factor of progression or early recurrence of acute non- cardioembolic ischemic stroke.