Systemic Risk Score Evaluation in Ischaemic Stroke Patients (SCALA): A prospective cross-sectional study in 85 German stroke units

November 2007

Stratification of patients with transient ischemic attack (TIA) or ischaemic stroke (IS) by risk of recurrent stroke can contribute to optimized secondary prevention.

C. Weimar and his colleagues from the University of Duisburg-Essen, Germany, therefore aimed to assess cardiovascular risk-factor profiles of consecutive patients hospitalized with TIA or IS to stratify the risk of recurrent stroke according to the Essen Stroke Risk Score (ESRS) and of future cardiovascular events according to the ankle brachial index (ABI) as a marker of generalized atherosclerosis.

In this cross-sectional observational study, 85 neurological stroke units throughout Germany documented cardiovascular risk factor profiles of 10 consecutive TIA or IS patients on standardized questionnaires. Screening for Peripheral Arterial Disease (PAD) was done with Doppler ultrasonography to calculate the ABI.

A total of 852 patients (57% men) with a mean age of 67±12.4 years were included of whom 82.9 % had IS. The median National Institutes of Health stroke sum score was 4 (TIA: 1). Arterial hypertension was reported in 71%, diabetes mellitus in 26%, clinical PAD in 10%, and an ABI ≤ 0.9 in 51%. An ESRS ≥ 3 was observed in 58%, which in two previous retrospective analyses corresponded to a recurrent stroke risk of ≥ 4%/year. The correlation between the ESRS and the ABI was low (r = 0.21).

The investigators found that a high proportion of patients had asymptomatic atherosclerotic disease and a considerable risk of recurrent stroke according to the ABI and ESRS category.

"The prognostic accuracy as well as the potential benefit of various risk stratification scores in secondary stroke prevention require validation in a larger prospective study," the authors stated.