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Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool
BACKGROUND AND PURPOSE: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378416/ https://www.ncbi.nlm.nih.gov/pubmed/34266308 http://dx.doi.org/10.1161/STROKEAHA.120.032935 |
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author | Venema, Esmee Roozenbeek, Bob Mulder, Maxim J.H.L. Brown, Scott Majoie, Charles B.L.M. Steyerberg, Ewout W. Demchuk, Andrew M. Muir, Keith W. Dávalos, Antoni Mitchell, Peter J. Bracard, Serge Berkhemer, Olvert A. Lycklama à Nijeholt, Geert J. van Oostenbrugge, Robert J. Roos, Yvo B.W.E.M. van Zwam, Wim H. van der Lugt, Aad Hill, Michael D. White, Philip Campbell, Bruce C.V. Guillemin, Francis Saver, Jeffrey L. Jovin, Tudor G. Goyal, Mayank Dippel, Diederik W.J. Lingsma, Hester F. |
author_facet | Venema, Esmee Roozenbeek, Bob Mulder, Maxim J.H.L. Brown, Scott Majoie, Charles B.L.M. Steyerberg, Ewout W. Demchuk, Andrew M. Muir, Keith W. Dávalos, Antoni Mitchell, Peter J. Bracard, Serge Berkhemer, Olvert A. Lycklama à Nijeholt, Geert J. van Oostenbrugge, Robert J. Roos, Yvo B.W.E.M. van Zwam, Wim H. van der Lugt, Aad Hill, Michael D. White, Philip Campbell, Bruce C.V. Guillemin, Francis Saver, Jeffrey L. Jovin, Tudor G. Goyal, Mayank Dippel, Diederik W.J. Lingsma, Hester F. |
author_sort | Venema, Esmee |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice. METHODS: We used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic. RESULTS: We included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (<1%) predicted treatment benefit (n=135/3156 [4.3%]) had low rates of functional independence, irrespective of reperfusion status, suggesting potential absence of treatment benefit. The updated model was made available online for clinicians and researchers at www.mrpredicts.com. CONCLUSIONS: Because of the substantial treatment effect and small potential harm of EVT, most patients arriving within 6 hours at an endovascular-capable center should be treated regardless of their clinical characteristics. MR PREDICTS can be used to support clinical judgement when there is uncertainty about the treatment indication, when resources are limited, or before a patient is to be transferred to an endovascular-capable center. |
format | Online Article Text |
id | pubmed-8378416 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-83784162021-08-20 Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool Venema, Esmee Roozenbeek, Bob Mulder, Maxim J.H.L. Brown, Scott Majoie, Charles B.L.M. Steyerberg, Ewout W. Demchuk, Andrew M. Muir, Keith W. Dávalos, Antoni Mitchell, Peter J. Bracard, Serge Berkhemer, Olvert A. Lycklama à Nijeholt, Geert J. van Oostenbrugge, Robert J. Roos, Yvo B.W.E.M. van Zwam, Wim H. van der Lugt, Aad Hill, Michael D. White, Philip Campbell, Bruce C.V. Guillemin, Francis Saver, Jeffrey L. Jovin, Tudor G. Goyal, Mayank Dippel, Diederik W.J. Lingsma, Hester F. Stroke Original Contributions BACKGROUND AND PURPOSE: Benefit of early endovascular treatment (EVT) for ischemic stroke varies considerably among patients. The MR PREDICTS decision tool, derived from MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), predicts outcome and treatment benefit based on baseline characteristics. Our aim was to externally validate and update MR PREDICTS with data from international trials and daily clinical practice. METHODS: We used individual patient data from 6 randomized controlled trials within the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) collaboration to validate the original model. Then, we updated the model and performed a second validation with data from the observational MR CLEAN Registry. Primary outcome was functional independence (defined as modified Rankin Scale score 0–2) 3 months after stroke. Treatment benefit was defined as the difference between the probability of functional independence with and without EVT. Discriminative performance was evaluated using a concordance (C) statistic. RESULTS: We included 1242 patients from HERMES (633 assigned to EVT, 609 assigned to control) and 3156 patients from the MR CLEAN Registry (all of whom underwent EVT within 6.5 hours). The C-statistic for functional independence was 0.74 (95% CI, 0.72–0.77) in HERMES and, after model updating, 0.80 (0.78–0.82) in the Registry. Median predicted treatment benefit of routinely treated patients (Registry) was 10.3% (interquartile range, 5.8%–14.4%). Patients with low (<1%) predicted treatment benefit (n=135/3156 [4.3%]) had low rates of functional independence, irrespective of reperfusion status, suggesting potential absence of treatment benefit. The updated model was made available online for clinicians and researchers at www.mrpredicts.com. CONCLUSIONS: Because of the substantial treatment effect and small potential harm of EVT, most patients arriving within 6 hours at an endovascular-capable center should be treated regardless of their clinical characteristics. MR PREDICTS can be used to support clinical judgement when there is uncertainty about the treatment indication, when resources are limited, or before a patient is to be transferred to an endovascular-capable center. Lippincott Williams & Wilkins 2021-07-16 2021-09 /pmc/articles/PMC8378416/ /pubmed/34266308 http://dx.doi.org/10.1161/STROKEAHA.120.032935 Text en © 2021 The Authors. https://creativecommons.org/licenses/by/4.0/Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. |
spellingShingle | Original Contributions Venema, Esmee Roozenbeek, Bob Mulder, Maxim J.H.L. Brown, Scott Majoie, Charles B.L.M. Steyerberg, Ewout W. Demchuk, Andrew M. Muir, Keith W. Dávalos, Antoni Mitchell, Peter J. Bracard, Serge Berkhemer, Olvert A. Lycklama à Nijeholt, Geert J. van Oostenbrugge, Robert J. Roos, Yvo B.W.E.M. van Zwam, Wim H. van der Lugt, Aad Hill, Michael D. White, Philip Campbell, Bruce C.V. Guillemin, Francis Saver, Jeffrey L. Jovin, Tudor G. Goyal, Mayank Dippel, Diederik W.J. Lingsma, Hester F. Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title | Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title_full | Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title_fullStr | Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title_full_unstemmed | Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title_short | Prediction of Outcome and Endovascular Treatment Benefit: Validation and Update of the MR PREDICTS Decision Tool |
title_sort | prediction of outcome and endovascular treatment benefit: validation and update of the mr predicts decision tool |
topic | Original Contributions |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8378416/ https://www.ncbi.nlm.nih.gov/pubmed/34266308 http://dx.doi.org/10.1161/STROKEAHA.120.032935 |
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