Analysis Of ESRS Combined With CISS Classification In Predicting Recurrence Of Cerebral Infarction

[Objective]Cerebral infarction(CI)is a common clinical disease with very high incidence,mortality,disability and recurrence rates.The recurrence of CI can cause more serious clinical consequences,for instance:the patients may lose the survivability and work ability;the patients who are paralyzed in bed need others to take care of;more serious ones lose their lives.All the situations bring great mental and economic burden to the patients and their families.Therefore,how to prevent the recurrence of CI is an important topic in neurology.It is important for the secondary prevention of CI to identify patients with high risk of recurrent stroke taking advantage of forecasting tools of the risk of the recurrence and to take a more active and effective stratified treatment.This study assesses the reliability of the ESSEN Stroke Risk Rating Score(ESRS)for predictive value of CI recurrence,explores the predictive value of Modified ESRS scores which combines the ESRS with CISS typing for CI recurrence,and screens out more accurate predictive models.[Methods]This study was conducted in the First Hospital of Dalian Medical University.We payed close attention to the 404 patients who were attacked by CI from June 1,2015 to January 31,2016.The data which belongs to ESRS rating scale is collected,including age,history of hypertension,history of diabetes,history of coronary heart disease and other heart disease,history of smoking,history of peripheral vascular disease,history of TIA or other CI.We also note the data of sex,history of atrial fibrillation,ESRS score,and the athogenesis of CI.Cerebrovascular disease secondary prevention health education was provided to the patients before they discharged.And according to the pathogenesis of the diseases,and the risk factors for cerebrovascular disease,secondary prevention medication is suggested.Patients were followed up for 1 year whether they were attacked by cerebral infarction the second time.The t-test,chi-square test and ROC curve were used to analyze the collected cases.[Results and discussion]In this study,404 patients met the inclusion criteria,19 of whom died and 16 were lost,369 ones were followed-up and the follow-up rate is 91.34%.According to the recurrence,the objects are divided into two groups,the recurrence group contains 54 cases,while,the other contains 315 cases,and the recurrence rate is 14.6%.The differences of the general condition,risk factors,ESRS score and CISS classification were compared between the follow-up patients and the patients who were lost.P value was greater than 0.05,the difference was not statistically significant.To compare the recurrence rate of different cause mechanism group,cardiac embolism group(20%),unexplained group(16.2%),atherosclerosis group(14.5%)and perforator artery disease group(10.7%).The recurrence rate of different mechanism group of atherosclerosis is low perfusion/embolus clearance rate decreased(25%),arterial to arterial embolization(16.3%),blocked perforation(10.9%).Patients with noncardiogenic stroke were stratified according to the ESRS score.0-2 divided into low-risk group,while 3-9 divided into high-risk group,and the recurrence rates were 9.4%and 17.6%(P=0.033).Mapping the ROC curve of stroke recurrence predicted by ESRS,the area under the curve is 0.61.Bring CISS classification into the ESRS score to improve the ESRS score,and atherosclerosis type 2 points,perforation artery disease type 1 point.Once again,the risk stratification is based on the score,0-3 divided into low-risk group,while 4-11 divided into high-risk group,and the recurrence rates were 7.2%and 15.6%.ESRS score and Modified ESRS score predict the recurrence of cerebral infarction AUC values were 0.57 and 0.577,but there is no statistically significant.[Conclusion]1.ESRS scores have a better risk of stratification for noncardiogenic stroke,and can effectively predict the risk of recurrence2.There were differences in the recurrence rates among CISS types,LAA type,CS type and UE type recurrence rate is higher,PAD type recurrence rate is the lowest.3.Modified ESRS scores can effectively stratify the risk of recurrence of CI in LAA and PAD patients;but there is no significant difference compared with ESRS.