Using a risk stratification score can help in detecting patients with embolic stroke of undetermined source who are at risk of recurrence of stroke.¹

In this study, researchers from China endeavored to define risk factors for stroke recurrence in patients with embolic stroke of undetermined source. For this, they selected 2415 participants from the Third China National Stroke Registry. A scoring system was developed and validated to stratify the risk. The variables used were hypertension (2 points), diabetes (3 points), multiple stage infarction (4 points), watershed infarcts (2 points), left atrial diameter index (per increasing 2.5 mm/m2; 1 point) and no statin at discharge (3 points). The total score range was 0 to 15 points. There were 1611 participants in the derivation and 804 in the validation sample.

The risk of stroke recurrence was highest (26.8%) among patients whose scores ranged between 11 and 15. The risk was just around 6% in low scoring (0-5) patients; it was 9.4% in patients with intermediate risk who scored between 6 and 10. The study also found that “the AUC (area under curve of receiver operator characteristic curve) of the score in the derivation cohort and validation cohort was, respectively, 0.60 and 0.63”.

These findings from a recent study are published in the journal Neurology.¹

Embolic strokes of undetermined source are a subtype of ischemic stroke, where no known cause can be identified on evaluation. They account for around 17% of all ischemic strokes; the recurrence rate ranges between 4% and 5%.² This study has demonstrated the clinical utility of the scoring system in identifying patients at risk of stroke recurrence, which facilitates timely initiation of secondary prevention measures.

References

1. Jing J, et al. A score to predict the stroke recurrence of patients with embolic stroke of undetermined source. J Neurol. 2022 Dec;269(12):6428-6435. doi: 10.1007/s00415-022-11277-7.
2. Bahit MC, et al. Predictors of atrial fibrillation development in patients with embolic stroke of undetermined source: an analysis of the RE-SPECT ESUS trial. Circulation. 2021 Nov 30;144(22):1738-1746. doi: 10.1161/CIRCULATIONAHA.121.055176.