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ABSTRACT
Background and purpose: To develop and validate a risk model (Extracranial Carotid Artery Stenosis progression score, ECAS-PS) and to predict risk of ECAS progression.
Methods: The ECAS-PS was developed based on the Renqiu Stroke Screening Study (RSSS), in which eligible participants were randomly divided into derivation (60%) and validation (40%) cohorts. ECAS at baseline and follow-up was diagosed by carotid duplex ultrasound according to the published criteria. ECAS progression was defined as an increase in ECAS to≥50% for those with a baseline of <50% or as an increase to a higher category of stenosis if the baseline stenosis was ≥50%. Independent predictors of ECAS progression were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer–Lemeshow test were used to assess model discrimination and calibration.
Results: A total of 4111 participants were included and the mean age was 64.3. A total number of 29 (0.7%), 24 (0.6%) and 48 (1.2%) patients progressed during 2-year follow-up for left, right and bilateral (either left or right) carotid artery, respectively. The ECAS-PS was developed from a set of predictors of ECAS progression. The ECAS-PS demonstrated good discrimination in both the derivation and validation cohorts (AUROC range: 0.824–0.917). The Hosmer–Lemeshow tests of ECAS progression score were not significant in the derivation and validation cohorts (all P > 0.05).
Conclusion: The ECAS progression score is a valid model for predicting the risk of ECAS progression. Further validation of the ECAS-PS in different populations and larger samples is warranted.
Disclosure statement
No potential conflict of interest was reported by the authors.
Supplementary material
Supplementary data can be accessed here.
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Notes on contributors
Ruijun Ji
Ruijun Ji is a senior neurologist at Beijing Tiantan hospital. He was a fellow of Massachusetts general hospital (MGH) and Visiting scholar at Duke Clinical Research Institute (Duke University) and Department of Statistics & Operations Research (University of North Carolina at Chapel Hill). Dr. Ji was good at stroke management, especially acute stroke care, stroke prevention and acute stroke rehabilitation. Dr. Ji have established a bunch of risk models for predicting medical complications, such as in-hospital pneumonia, gastrointestinal bleeding and deep vein thrombosis after acute stroke. Meanwhile, Dr. Ji have developed and validated risk model for dynamic functional outcomes after acute ischemic stroke and intracerebral hemorrhage.
Kai Yu
Kai Yu is a senior neurologist, who is good at acute stroke care and stroke prevention.
Guoyang Li
Guoyang Li is a neurologist, who is interested in acute stroke care and stroke prevention.
Xinyu Liu
Xinyu Liu is a neurologist, who is interested in brain function reconstruction after acute stroke.
Yinglin Yan
Yinglin Yan is a senior neurologist, who is good at acute stroke care and stroke prevention.
Suying Gao
Suying Gao is a neurologist, who is interested in acute stroke care and stroke prevention.
Hongna Yang
Hongna Yang is a neurologist, who is interested in stroke prevention.
Shangmin Qin
Shangmin Qin is a senior sonologist, who is good at carotid artery ultrasound and transcranial Doppler.
Fang Li
Fang Li is a neurologist, who is interested in acute stroke care and quality of stroke management.
Guangbo Zhang
Guangbo Zhang is a neurologist, who is interested in intensive stroke care.
Bo Yang
Bo Yang is a cardiologist, who is interested in management of acute coronary syndrome.
Yan He
Yan He is an endocrinologist, who is interested in diagnosis and management of diabetes mellitus and associated medical complications.
Yongna Zhao
Yongna Zhao is a neurologist, who is interested in stroke prevention and management of metallic syndrome.
Enjing Li
Enjing Li is a cardiologist, who is interested in coronary artery disease prevention.
Lihua Xu
Lihua Xu is a neurologist, who is interested in stroke prevention.
Na Zhang
Na Zhang is a neurologist, who is interested in stroke prevention.
Dongna Fan
Dongna Fan is a cardiologist, who is interested in management of coronary artery disease and heart failure.
Dongliang Liu
Dongliang Liu is a cardiologist, who is interested in acute care of coronary artery disease.