Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/26071
Title: Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies.
Austin Authors: Best, Jonathan G;Ambler, Gareth;Wilson, Duncan;Lee, Keon-Joo;Lim, Jae-Sung;Shiozawa, Masayuki;Koga, Masatoshi;Li, Linxin;Lovelock, Caroline;Chabriat, Hugues;Hennerici, Michael;Wong, Yuen Kwun;Mak, Henry Ka Fung;Prats-Sanchez, Luis;Martínez-Domeño, Alejandro;Inamura, Shigeru;Yoshifuji, Kazuhisa;Arsava, Ethem Murat;Horstmann, Solveig;Purrucker, Jan;Lam, Bonnie Yin Ka;Wong, Adrian;Kim, Young Dae;Song, Tae-Jin;Lemmens, Robin;Eppinger, Sebastian;Gattringer, Thomas;Uysal, Ender;Tanriverdi, Zeynep;Bornstein, Natan M;Ben Assayag, Einor;Hallevi, Hen;Molad, Jeremy;Nishihara, Masashi;Tanaka, Jun;Coutts, Shelagh B;Polymeris, Alexandros;Wagner, Benjamin;Seiffge, David J;Lyrer, Philippe;Algra, Ale;Kappelle, L Jaap;Al-Shahi Salman, Rustam;Jäger, Hans R;Lip, Gregory Y H;Fischer, Urs;El-Koussy, Marwan;Mas, Jean-Louis;Legrand, Laurence;Karayiannis, Christopher;Phan, Thanh;Gunkel, Sarah;Christ, Nicolas;Abrigo, Jill;Leung, Thomas;Chu, Winnie;Chappell, Francesca;Makin, Stephen;Hayden, Derek;Williams, David J;Mess, Werner H;Nederkoorn, Paul J;Barbato, Carmen;Browning, Simone;Wiegertjes, Kim;Tuladhar, Anil M;Maaijwee, Noortje;Guevarra, Anne Cristine;Yatawara, Chathuri;Mendyk, Anne-Marie;Delmaire, Christine;Köhler, Sebastian;van Oostenbrugge, Robert;Zhou, Ying;Xu, Chao;Hilal, Saima;Gyanwali, Bibek;Chen, Christopher;Lou, Min;Staals, Julie;Bordet, Régis;Kandiah, Nagaendran;de Leeuw, Frank-Erik;Simister, Robert;Hendrikse, Jeroen;Kelly, Peter J;Wardlaw, Joanna;Soo, Yannie;Fluri, Felix;Srikanth, Velandai;Calvet, David;Jung, Simon;Kwa, Vincent I H;Engelter, Stefan T;Peters, Nils;Smith, Eric E;Hara, Hideo;Yakushiji, Yusuke;Orken, Dilek Necioglu;Fazekas, Franz;Thijs, Vincent N ;Heo, Ji Hoe;Mok, Vincent;Veltkamp, Roland;Ay, Hakan;Imaizumi, Toshio;Gomez-Anson, Beatriz;Lau, Kui Kai;Jouvent, Eric;Rothwell, Peter M;Toyoda, Kazunori;Bae, Hee-Joon;Marti-Fabregas, Joan;Werring, David J
Affiliation: Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
A A Martinos Center for Biomedial Imaging, Department of Neurology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA; Takeda, Cambridge, MA, USA
Department of Neurology, National Neuroscience Institute, Singapore
Memory Aging & Cognition Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
Department of Radiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Donders Centre for Medical Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, The Netherlands
Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
A A Martinos Center for Biomedial Imaging, Department of Neurology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK
UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
New Zealand Brain Research Institute, Christchurch, New Zealand
Calgary Stroke Program, Department of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
Department of Neurosurgery, Kushiro City General Hospital, Kushiro, Japan
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan
Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan; Department of Neurology, Kansai Medical University, Osaka, Japan
UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Switzerland
Department of Neurology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
Department of Diagnostic and Interventional Neuroradiology, University Hospital Inselspital Bern, University of Bern, Bern, Switzerland
Department for Neurology and Neurorehabilitation, Neurocenter, Lucerne State Hospital, Lucerne, Switzerland
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
Liverpool Heart & Chest Hospital, Liverpool, UK
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark..
Neurology and Neurorehabilitation, Department of Geriatric Medicine FELIX PLATTER, University of Basel, Switzerland
Centre for Clinical Brain Sciences, Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
Assistance Publique - Hôpitaux de Paris, Lariboisière Hospital, Department of Neurology, Paris, France; Federation Hospitalo-Universitaire NeuroVasc, Université de Paris, Paris, France; INSERM U1141, Paris, France
Degenerative and vascular cognitive disorders, University of Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France
Department of Neurology, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Université de Paris, Paris, France
Department of Neuroradiology, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris, INSERM, Université de Paris, Paris, France
Degenerative and vascular cognitive disorders, University of Lille, INSERM, Centre Hospitalier Universitaire de Lille, Lille, France; Department of Radiology, Fondation A de Rothschild, Paris, France
Department of Neurology and Neurosurgery, Utrecht University, Utrecht, The Netherlands
Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands; Department of Neurology and Neurosurgery, Utrecht University, Utrecht, The Netherlands
Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
Department of Neurology, Amsterdam University Medical Centres, Netherlands
Department of Clinical Neurophysiology, Maastricht University Medical Centre, Maastricht, the Netherlands
Department of Neurology, Hallym Neurological Institute, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
Department of Neurology, The 2nd affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
Division of Neurology, Department of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany; Department of Brain Sciences, Imperial College London, London, UK
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
Lysholm Department of Neuroradiology and the Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, University College London Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, UK
Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Department of Statistical Science, University College London, Gower Street, London, UK
UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK
Therese Pei Fong Chow Research Centre for Prevention of Dementia, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
Stroke and Ageing Research Group, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
Centre for Clinical Brain Sciences, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Special Administrative Region, China
The Florey Institute of Neuroscience and Mental Health
Department of Neurology, Austin Health, Heidelberg, VIC, Australia
Peninsula Clinical School, Peninsula Health, Monash University, Melbourne, Australia
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain..
Experimental Neurology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium; Vlaams Instituut voor Biotechnologie, Center for Brain & Disease Research; Department of Neurology, University Hospitals Leuven, Leuven, Belgium..
Department of Neurology, Medical University of Graz, Graz, Austria..
Department of Radiology, Saglık Bilimleri University, Sisli Etfal Education and Research Hospital, Istanbul, Turkey..
Department of Neurology, İzmir Katip Çelebi University Atatürk Education and Research Hospital, İzmir Turkey..
Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel..
The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland..
Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences Dublin, Ireland; Department of Geriatric and Stroke Medicine, Beaumont Hospital Dublin, Ireland..
The Neurovascular Research Unit and Health Research Board, Stroke Clinical Trials Network Ireland, University College Dublin, Dublin, Ireland..
Memorial Sisli Hospital, Department of Neurology, Istanbul, Turkey..
Department of Neurology, Medical University of Graz, Graz, Austria..
Unit of Neuroradiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain..
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, Barcelona, Spain..
Neurology
Issue Date: 20-Apr-2021
Date: 2021
Publication information: The Lancet. Neurology 2021; 20(4): 294-303
Abstract: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. British Heart Foundation and Stroke Association.
URI: https://ahro.austin.org.au/austinjspui/handle/1/26071
DOI: 10.1016/S1474-4422(21)00024-7
Journal: The Lancet. Neurology
PubMed URL: 33743239
Type: Journal Article
Appears in Collections:Journal articles

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