The ASTRAL score to predict functional outcome in

Let’s design the ideal prognostic score… • not too many variables • readily available

ASTRAL registry (Lausanne/Switzerland) n=1645 Development of the prognostic score Double external validation of the

Take-home messages • the ASTRAL score is a very reliable prognostic score • it

Oxford Handicap Scale score < 3 Stroke 2002; 33: 1041 -1047

logit(BI<95) = -5. 782 + (0. 049*age) + (0. 272*NIHSS) Stroke 2004; 35: 158

-Score by Weimar et al. - Validation in the VISTA dataset Stroke 2008; 39;

Predictors of long-term outcome ASTRAL score (per 1 point increase) Atrial fibrillation Heart Failure

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The ASTRAL score to predict functional outcome in acute ischemic stroke George Ntaios University of Thessaly, Larissa, Greece

Let’s design the ideal prognostic score… • not too many variables • readily available variables • simple to calculate • applicable as early as possible • widely-used scale for outcome assessment • validated externally • Modified Rankin Scale score • validated in large population • Barthel index • Glasgow outcome scale • validated in multiple populations • Oxford Handicap Scale

ASTRAL registry (Lausanne/Switzerland) n=1645 Development of the prognostic score Double external validation of the prognostic score Prognostic point-based score Athens Stroke Registry n=1659 Vienna Stroke registry n=653 Color chart

P=0. 43

ASTRAL registry (Lausanne/Switzerland) n=1645 Development of the prognostic score Double external validation of the prognostic score Prognostic point-based score Athens Stroke registry n=1659 Vienna Stroke registry n=653 Color chart

P=0. 22

P=0. 49

P=0. 82

Take-home messages • the ASTRAL score is a very reliable prognostic score • it calculates the probability of poor outcome at three months • it can be used already at admission • it is very simple to use, especially with the help of the color chart

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Oxford Handicap Scale score < 3 Stroke 2002; 33: 1041 -1047

logit(BI<95) = -5. 782 + (0. 049*age) + (0. 272*NIHSS) Stroke 2004; 35: 158 -162

Stroke 2008; 39; 1821 -1826

-Score by Weimar et al. - Validation in the VISTA dataset Stroke 2008; 39; 1821 -1826 -ASTRAL score - Validation in pooled Athens/Vienna dataset Neurology 2012; 78: 1916– 1922

Stroke 2011; 42: 3421 -3428

P=0. 43 P=0. 49 P=0. 22 P=0. 82

Predictors of long-term outcome ASTRAL score (per 1 point increase) Atrial fibrillation Heart Failure Stroke subtypes Lacunar Atherosclerotic Cardioembolic Undetermined 5 -year unfavourable outcome (m. RS=3 -6) 1. 09 (1. 08 – 1. 10)* 1. 53 (1. 14 – 2. 04)† 1. 56 (1. 14 – 2. 13)† 1 1. 71 (1. 10 – 2. 66)‡ 1. 65 (1. 03 – 2. 63)‡ 2. 82 (1. 84 – 4. 34)* 5 -year mortality 1. 09 (1. 08 – 1. 10)* 1 1. 14 (0. 67 – 1. 94) 1. 74 (1. 02 – 2. 97)‡ 2. 39 (1. 46 – 3. 93)* 0. 74 (0. 58 – 0. 95)‡

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