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The ASTRAL score to predict functional outcome in acute
ischemic stroke
Univers i ty of Thessa ly , Lar issa, Greece
George Nta ios
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Let’s design the ideal prognostic score…
• not too many variables • readily available variables• simple to calculate• applicable as early as possible• widely-used scale for outcome assessment • validated externally • validated in large population• validated in multiple populations
•Modified Rankin Scale score•Barthel index•Glasgow outcome scale•Oxford Handicap Scale
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ASTRAL registry (Lausanne/Switzerland)n=1645
Athens Stroke Registryn=1659
Vienna Stroke registryn=653
Development of the prognostic score
Double external validation of the prognostic score
Prognostic point-based score
Color chart
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P=0.43
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ASTRAL registry (Lausanne/Switzerland)n=1645
Athens Stroke registryn=1659
Vienna Stroke registryn=653
Development of the prognostic score
Double external validation of the prognostic score
Prognostic point-based score
Color chart
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P=0.22
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P=0.49
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P=0.82
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ASTRAL registry (Lausanne/Switzerland)n=1645
Athens Stroke Registryn=1659
Vienna Stroke Registryn=653
Development of the prognostic score
Double external validation of the prognostic score
Prognostic point-based score
Color chart
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Take-home messages
• the ASTRAL score is a very reliable prognostic score• it calculates the probability of poor outcome at three months• it can be used already at admission• it is very simple to use, especially with the help of the color chart
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Spare slides
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Stroke 2002; 33: 1041-1047
Oxford Handicap Scale score < 3
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logit(BI<95) = -5.782 + (0.049*age) + (0.272*NIHSS)
Stroke 2004;35:158-162
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Stroke 2008;39;1821-1826
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-ASTRAL score- Validation in pooled Athens/Vienna dataset
-Score by Weimar et al.- Validation in the VISTA dataset
Stroke 2008;39;1821-1826 Neurology 2012;78:1916–1922
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Stroke 2011;42:3421-3428
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Stroke 2011;42:3421-3428
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Stroke 2011;42:3421-3428
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P=0.43 P=0.22
P=0.49 P=0.82
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5-year unfavourable outcome (mRS=3-6)
5-year mortality
ASTRAL score (per 1 point increase)
1.09 (1.08 – 1.10)* 1.09 (1.08 – 1.10)*
Atrial fibrillation 1.53 (1.14 – 2.04)†
Heart Failure 1.56 (1.14 – 2.13)†
Stroke subtypes 1 1 Lacunar 1.71 (1.10 – 2.66)‡ 1.14 (0.67 – 1.94) Atherosclerotic 1.65 (1.03 – 2.63)‡ 1.74 (1.02 – 2.97)‡
Cardioembolic 2.82 (1.84 – 4.34)* 2.39 (1.46 – 3.93)*
Undetermined 0.74 (0.58 – 0.95)‡
Predictors of long-term outcome