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@#To systematically evaluate the predictive performance of ESRS on the outcomes of recurrent “ischemic stroke” and “cardiovascular events”. MethodsA systematic search was conducted on CNKI，VIP，PubMed，Web of Science，Embase，to collect external validation studies of ESRS. The search time was from 2010.1 to 2021.1.Then two researchers independently screened and evaluated the included literatures. The discrimination of the prediction models was measured by C-statistic in random effects meta-analysis. And，examining performance in systematic review. Results8 studies with “ischemic stroke” as the outcome were included. Meta-analysis results showed that ESRS had rather poor discrimination（C-statistic=0.62，95%CI 0.59～0.69），and there was heterogeneity among studies（PI 0.49～0.78）. In the analysis of heterogeneous sources，there were 2 literatures in which patients received secondary preventive treatment，and the prediction effect was poor（C statistics were lower than 0.60）；There were 2 literatures included in TIA and mild cerebral infarction population，which had good prediction effect（C statistics were 0.69 and 0.70，respectively）. There were 8 studies with “cardiovascular events” as outcome. Meta-analysis results showed that ESRS had helpful predictive performance（C-statistic=0.60，95%CI 0.58～0.66），and there was heterogeneity among studies（PI 0.56～0.70）. In the analysis of heterogeneous sources，the patients in 4 literatures received secondary preventive treatment，but the prediction results were poor（C statistic was 0.55～0.59）. In the prediction of TIA and mild cerebral infarction population，1 literature achieved good prediction effect（C statistic was 0.65），while the prediction effect reported in other studies was poor（C statistic was 0.56～0.61）. ConclusionsExisting evidence shows that ESRS has a certain ability to predict the outcome of “ischemic stroke”and “cardiovascular events”，but the overall discrimination is only between 0.60 and 0.62，and the prediction effect is not satisfactory. People receiving secondary preventive treatment，TIA and mild cerebral infarction may affect the predictive effect of ESRS. The prediction ability of ESRS needs to be verified by more high-quality studies.
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Objective To investigate the relationship between intracranial atherosclerotic plaque stability and stroke recurrence risk.Methods Forty-eight patients with acute ischemic stroke caused by intracranial atherosclerosis in Guangdong Province Hospital of TCM were analyzed retrospectively.After the Essen Stroke Risk Scale (ESRS) was used to assess the risk factors for the patients,they were divided into either an ESRS ≥3 group (n=21 in the high-risk recurrence group) or an ESRS <3 group (n=27 in the low-risk recurrence group).Both groups of patients underwent high-resolution MR imaging (HR-MRI) examinations of the intracranial guilty vessels (basilar artery or unilateral middle cerebral artery).According to the signal intensity of HR-MRI on the T1-weighted imaging,T2-weighted imaging,and T1 fat suppression sequences,the intracranial atherosclerotic stable plaques and unstable plaques were distinguished.The stabilization of intracranial atherosclerotic plaques was compared in patients of both groups.Results There were significant differences in the age and incidences of hypertension,diabetes mellitus,and unstable plaques in patients of both groups (P<0.05).Further multivariate logistic regression analysis of the four factors showed that the age,hypertension,diabetes,and intracranial atherosclerotic unstable plaques were the high-risk factors for recurrent ischemic stroke (ORs,87.114,159.423,8.942,and 11.551,respectively;95%CIs 4.218-1 799.078,3.235-7 855.957,1.054-75.857,and 1.011-132.043,respectively;all P<0.05).Conclusion In addition to the traditional risk factors such as age,hypertension,and diabetes,the intracranial atherosclerotic unstable plaque is an independent risk factor for high-risk recurrence of ischemic stroke.
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Objective To explore the predictive value of modified version Essen stroke risk score (ESRS) for recurrent cerebral infarction in 1 year. Methods Factors ofcerebrovascular stenosisand≥ 2 lesions in diffusion weighted imaging (DWI) which reflected large vascular stenosis and unstable plaques to the ESRS were added, and the 2 factors of other cardiovascular diseases and“peripheral vascular disease”which were difficult to operate clinically and had a lower incidence compared with the European and American people were got rid of. Thus, the total score of the modified version ESRS was still 9 scores. The risk of recurrent cerebral infarction in 1 year in 263 patients with cerebral infarction were evaluated by ESRS and modified version ESRS, and the predictive value was evaluated by area under receiver-operating characteristics (ROC) curve. Results The incidence of recurrent cerebral infarction in 1 year in 263 patients with cerebral infarction was 15.59% (41/263). There were statistical differences in the incidences of recurrent cerebral infarction in 1 year for different risk stratification patients by 2 methods (P<0.01). Multiple factor Logistic regression analysis results showed that thecerebrovascular stenosisand≥2 lesions in DWIwere the independent risk factors in predicting recurrent cerebral infarction in 1 year (OR=12.48 and 18.72, 95%CI 5.083-30.641 and 7.718-43.242, P=0.000 and 0.000). The area under ROC of predicting recurrent cerebral infarction in 1 year by ESRS and modified version ESRS was 0.68 (95% CI 0.58- 0.79) and 0.70 (95% CI 0.60-0.79), and there was statistical difference (P<0.01). Conclusions The predictive value of modified version ESRS in recurrent cerebral infarction in 1 year is higher than that of ESRS, and it is an effective method.