PRE Score Validated to Predict Outcomes in Endovascular Treatment of Large Vessel Occlusion Strokes

October 27, 2015—The validity of the Pittsburgh Response to Endovascular Therapy (PRE) Score was supported by a study published by Srikant Rangaraju, MD, et al in the Journal of NeuroInterventional Surgery (JNIS, 2015;7:783–788). The investigators aimed to develop a clinically useful tool to identify patients who are likely to benefit from endovascular therapy, which they noted, seems to benefit a subset of patients with large vessel occlusion strokes. 

The investigators studied cohorts of patients from their respective institution: Grady Memorial Hospital (Grady) at Emory University in Atlanta, Georgia; University of Pittsburgh Medical Center (UPMC) in Pittsburgh, Pennsylvania; and Unitat d’Ictus Vall d’Hebron (UIVH) in Barcelona, Spain.

As summarized in JNIS, in a derivation cohort of consecutively treated patients with anterior circulation large vessel occlusion (Grady, n = 247), independent predictors (P < .1) of good outcome (90-day modified Rankin scale score 0–2) were determined using logistic regression to derive the PRE score as a predictor of good outcome. The PRE score was validated in two institutional cohorts (UPMC, n = 393; UIVH, n = 204) and its discriminative power for good outcome was compared with other validated tools. The benefit of successful recanalization was assessed in PRE score groups.

Independent predictors of good outcome in the derivation cohort (age, baseline National Institute of Health Stroke Scale [NIHSS] score, and Alberta Stroke Program Early CT Score [ASPECTS]) were used in the model: PRE score = age (years) + 2 X NIHSS – 10 X ASPECTS. 

The investigators reported that the PRE score was highly predictive of good outcomes in the derivation cohort (area under the curve [AUC] = .79) and validation cohorts (UPMC, AUC = .79; UIVH, AUC = .72) with comparable rates of good outcome in all PRE risk quartiles. PRE was superior to THRIVE, the Totaled Health Risks In Vascular Events score (P = .03), and SPAN, the Stroke Prognostication using Age and NIHSS score (P = .007); with a trend toward superiority to HIAT2, the Houston Intra-Arterial Therapy 2 score (P = .06) and iSCORE (P = .051) in predicting good outcomes. Better outcomes were associated with successful recanalization in patients with PRE scores −24 to +49, but not in patients with PRE scores < −24 or ≥ 50.

The PRE score is a validated tool that predicts outcomes and may facilitate patient selection for endovascular therapy in anterior circulation large vessel occlusions, concluded the investigators in JNIS.