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Systemic Risk Score Evaluation in Ischemic Stroke Patients (SCALA)

A prospective cross sectional study in 85 German stroke units

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Abstract

Background and purpose

Stratification of patients with transient ischemic attack (TIA) or ischemic stroke (IS) by risk of recurrent stroke can contribute to optimized secondary prevention. We therefore aimed to assess cardiovascular risk factor profiles of consecutive patients hospitalized with TIA/IS to stratify the risk of recurrent stroke according to the Essen Stroke Risk Score (ESRS) and of future cardiovascular events according to the ankle brachial index (ABI) as a marker of generalized atherosclerosis

Methods

In this cross-sectional observational study, 85 neurological stroke units throughout Germany documented cardiovascular risk factor profiles of 10 consecutive TIA/IS patients on standardized questionnaires. Screening for PAD was done with Doppler ultrasonography to calculate the ABI.

Results

A total of 852 patients (57% men) with a mean age of 67±12.4 years were included of whom 82.9 % had IS. The median National Institutes of Health stroke sum score was 4 (TIA: 1). Arterial hypertension was reported in 71%, diabetes mellitus in 26%, clinical PAD in 10%, and an ABI ≤ 0.9 in 51%. An ESRS ≥ 3 was observed in 58%, which in two previous retrospective analyses corresponded to a recurrent stroke risk of ≥ 4%/year. The correlation between the ESRS and the ABI was low (r = 0.21).

Conclusion

A high proportion of patients had asymptomatic atherosclerotic disease and a considerable risk of recurrent stroke according to the ABI and ESRS category. The prognostic accuracy as well as the potential benefit of various risk stratification scores in secondary stroke prevention require validation in a larger prospective study.

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Authors and Affiliations

  1. Dept. of Neurology, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    C. Weimar MD & H.-C. Diener MD

  2. Dept. of Neurology, University of Magdeburg, Germany

    M. Goertler MD

  3. Dept. of Neurology, Hospital Minden, Germany

    J. Röther MD

  4. Dept. of Neurology, University of Muenster, Germany

    E. B. Ringelstein MD & D. G. Nabavi MD

  5. Dept. of Cardiology, Vivantes Hospital Neukoelln, Berlin, Germany

    H. Darius MD

  6. Medical Department, Sanofi-Aventis, Berlin, Germany

    I.-H. Kim MD

  7. Biostatistics and Data Management, Sanofi-Aventis, Berlin, Germany

    K. Theobald

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  1. C. Weimar MD
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  4. E. B. Ringelstein MD
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  9. H.-C. Diener MD
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on behalf of the SCALA Study Group

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Correspondence to H.-C. Diener MD.

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Weimar, C., Goertler, M., Röther, J. et al. Systemic Risk Score Evaluation in Ischemic Stroke Patients (SCALA). J Neurol 254, 1562–1568 (2007). https://doi.org/10.1007/s00415-007-0590-z

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  • DOI: https://doi.org/10.1007/s00415-007-0590-z

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