Application of a nomogram model for the prediction of 90-day poor outcomes following mechanical thrombectomy in patients with acute anterior circulation large-vessel occlusion

Xia Li; Chen Li; Ao-Fei Liu; Chang-Chun Jiang; Yi-Qun Zhang; Yun-E Liu; Ying-Ying Zhang; Hao-Yang Li; Wei-Jian Jiang; Jin Lv

doi:10.3389/fneur.2024.1259973

Application of a nomogram model for the prediction of 90-day poor outcomes following mechanical thrombectomy in patients with acute anterior circulation large-vessel occlusion

Front Neurol. 2024 Jan 19:15:1259973. doi: 10.3389/fneur.2024.1259973. eCollection 2024.

Authors

Xia Li^#^{1

2}, Chen Li^#¹, Ao-Fei Liu^#¹, Chang-Chun Jiang², Yi-Qun Zhang¹, Yun-E Liu¹, Ying-Ying Zhang¹, Hao-Yang Li³, Wei-Jian Jiang¹, Jin Lv¹

Affiliations

¹ The PLA Rocket Force Characteristic Medical Center, Beijing, China.
² Department of Neurology, Baotou Center Hospital, Neurointerventional Medical Center of Inner Mongolia Medical University, Institute of Cerebrovascular Disease in Inner Mongolia, Inner Mongolia, China.
³ Department of Psychiatric Specialty, Capital Medical University, Beijing, China.

^# Contributed equally.

Abstract

Background: The past decade has witnessed advancements in mechanical thrombectomy (MT) for acute large-vessel occlusions (LVOs). However, only approximately half of the patients with LVO undergoing MT show the best/independent 90-day favorable outcome. This study aimed to develop a nomogram for predicting 90-day poor outcomes in patients with LVO treated with MT.

Methods: A total of 187 patients who received MT were retrospectively analyzed. Factors associated with 90-day poor outcomes (defined as mRS of 4-6) were determined by univariate and multivariate logistic regression analyzes. One best-fit nomogram was established to predict the risk of a 90-day poor outcome, and a concordance index was utilized to evaluate the performance of the model. Additionally, 145 patients from a single stroke center were retrospectively recruited as the validation cohort to test the newly established nomogram.

Results: The overall incidence of 90-day poor outcomes was 45.16%, affecting 84 of 186 patients in the training set. Moreover, five variables, namely, age (odds ratio [OR]: 1.049, 95% CI [1.016-1.083]; p = 0.003), glucose level (OR: 1.163, 95% CI [1.038-1.303]; p = 0.009), baseline National Institute of Health Stroke Scale (NIHSS) score (OR: 1.066, 95% CI [0.995-1.142]; p = 0.069), unsuccessful recanalization (defined as a TICI grade of 0 to 2a) (OR: 3.730, 95% CI [1.688-8.245]; p = 0.001), and early neurological deterioration (END, defined as an increase of ≥4 points between the baseline NIHSS score and the NIHSS score at 24 h after MT) (OR: 3.383, 95% CI [1.411-8.106]; p = 0.006), were included in the nomogram to predict the potential risk of poor outcomes at 90 days following MT in LVO patients, with a C-index of 0.763 (0.693-0.832) in the training set and 0.804 (0.719-0.889) in the validation set.

Conclusion: The proposed nomogram provided clinical evidence for the effective control of these risk factors before or during the process of MT surgery in LVO patients.

Keywords: acute ischemic stroke (AIS); large-vessel occlusion (LVO); mechanical thrombectomy (MT); nomogram; poor outcome; prognostic predictive model.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the grants from the National Key Basic Research Program of China (973 program) (grant no. 2013CB733805), the National Natural Science Foundation of China (grant no. 81871464), and the Joint Project of Inner Mongolia Medical University (grant no. YKD2021LH085).