Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Maurizio Paciaroni; Giancarlo Agnelli; Valeria Caso; Georgios Tsivgoulis; Karen L. Furie; Prasanna Tadi; Cecilia Becattini; Nicola Falocci; Marialuisa Zedde; Azmil H. Abdul-Rahim; Kennedy R. Lees; Andrea Alberti; Michele Venti; Monica Acciarresi; Cataldo D'Amore; Maria Giulia Mosconi; Ludovica Anna Cimini; Antonio Procopio; Paolo Bovi; Monica Carletti; Alberto Rigatelli; Manuel Cappellari; Jukka Putaala; Liisa Tomppo; Turgut Tatlisumak; Fabio Bandini; Simona Marcheselli; Alessandro Pezzini; Loris Poli; Alessandro Padovani; Luca Masotti; Vieri Vannucchi; Sung Il Sohn; Gianni Lorenzini; Rossana Tassi; Francesca Guideri; Maurizio Acampa; Giuseppe Martini; George Ntaios; Efstathia Karagkiozi; George Athanasakis; Kostantinos Makaritsis; Kostantinos Vadikolias; Chrysoula Liantinioti; Maria Chondrogianni; Nicola Mumoli; Domenico Consoli; Franco Galati; Simona Sacco; Antonio Carolei; Cindy Tiseo; Francesco Corea; Walter Ageno; Marta Bellesini; Giovanna Colombo; Giorgio Silvestrelli; Alfonso Ciccone; Umberto Scoditti; Licia Denti; Michelangelo Mancuso; Miriam Maccarrone; Giovanni Orlandi; Nicola Giannini; Gino Gialdini; Tiziana Tassinari; Maria Luisa De Lodovici; Giorgio Bono; Christina Rueckert; Antonio Baldi; Sebastiano D'Anna; Danilo Toni; Federica Letteri; Martina Giuntini; Enrico Maria Lotti; Yuriy Flomin; Alessio Pieroni; Odysseas Kargiotis; Theodore Karapanayiotides; Serena Monaco; Mario Maimone Baronello; Laszló Csiba; Lilla Szabó; Alberto Chiti; Elisa Giorli; Massimo Del Sette; Davide Imberti; Dorjan Zabzuni; Boris Doronin; Vera Volodina; Patrik Michel; Peter Vanacker; Kristian Barlinn; Lars Peder Pallesen; Jessica Kepplinger; Ulf Bodechtel; Johannes Gerber; Dirk Deleu; Gayane Melikyan; Faisal Ibrahim; Naveed Akhtar; Vanessa Gourbali; Shadi Yaghi

doi:10.1161/STROKEAHA.116.015770

Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

Maurizio Paciaroni, Giancarlo Agnelli, Valeria Caso, Georgios Tsivgoulis, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Nicola Falocci, Marialuisa Zedde, Azmil H. Abdul-Rahim, Kennedy R. Lees, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D'Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Antonio Procopio, Paolo Bovi, Monica CarlettiAlberto Rigatelli, Manuel Cappellari, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Fabio Bandini, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Luca Masotti, Vieri Vannucchi, Sung Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, Efstathia Karagkiozi, George Athanasakis, Kostantinos Makaritsis, Kostantinos Vadikolias, Chrysoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Domenico Consoli, Franco Galati, Simona Sacco, Antonio Carolei, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Giovanni Orlandi, Nicola Giannini, Gino Gialdini, Tiziana Tassinari, Maria Luisa De Lodovici, Giorgio Bono, Christina Rueckert, Antonio Baldi, Sebastiano D'Anna, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars Peder Pallesen, Jessica Kepplinger, Ulf Bodechtel, Johannes Gerber, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Shadi Yaghi

Research output: Contribution to journal › Article › peer-review

Abstract

Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.

Original language	English
Pages (from-to)	726-732
Number of pages	7
Journal	Stroke
Volume	48
Issue number	3
DOIs	https://doi.org/10.1161/STROKEAHA.116.015770
Publication status	Published - Mar 1 2017

Keywords

atrial fibrillation
myocardial infarction
risk stratification
stroke

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine
Advanced and Specialised Nursing

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10.1161/STROKEAHA.116.015770

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Paciaroni, M., Agnelli, G., Caso, V., Tsivgoulis, G., Furie, K. L., Tadi, P., Becattini, C., Falocci, N., Zedde, M., Abdul-Rahim, A. H., Lees, K. R., Alberti, A., Venti, M., Acciarresi, M., D'Amore, C., Mosconi, M. G., Cimini, L. A., Procopio, A., Bovi, P., ... Yaghi, S. (2017). Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study. Stroke, 48(3), 726-732. https://doi.org/10.1161/STROKEAHA.116.015770

Paciaroni, M, Agnelli, G, Caso, V, Tsivgoulis, G, Furie, KL, Tadi, P, Becattini, C, Falocci, N, Zedde, M, Abdul-Rahim, AH, Lees, KR, Alberti, A, Venti, M, Acciarresi, M, D'Amore, C, Mosconi, MG, Cimini, LA, Procopio, A, Bovi, P, Carletti, M, Rigatelli, A, Cappellari, M, Putaala, J, Tomppo, L, Tatlisumak, T, Bandini, F, Marcheselli, S, Pezzini, A, Poli, L, Padovani, A, Masotti, L, Vannucchi, V, Sohn, SI, Lorenzini, G, Tassi, R, Guideri, F, Acampa, M, Martini, G, Ntaios, G, Karagkiozi, E, Athanasakis, G, Makaritsis, K, Vadikolias, K, Liantinioti, C, Chondrogianni, M, Mumoli, N, Consoli, D, Galati, F, Sacco, S, Carolei, A, Tiseo, C, Corea, F, Ageno, W, Bellesini, M, Colombo, G, Silvestrelli, G, Ciccone, A, Scoditti, U, Denti, L, Mancuso, M, Maccarrone, M, Orlandi, G, Giannini, N, Gialdini, G, Tassinari, T, De Lodovici, ML, Bono, G, Rueckert, C, Baldi, A, D'Anna, S, Toni, D, Letteri, F, Giuntini, M, Lotti, EM, Flomin, Y, Pieroni, A, Kargiotis, O, Karapanayiotides, T, Monaco, S, Baronello, MM, Csiba, L, Szabó, L, Chiti, A, Giorli, E, Del Sette, M, Imberti, D, Zabzuni, D, Doronin, B, Volodina, V, Michel, P, Vanacker, P, Barlinn, K, Pallesen, LP, Kepplinger, J, Bodechtel, U, Gerber, J, Deleu, D, Melikyan, G, Ibrahim, F, Akhtar, N, Gourbali, V & Yaghi, S 2017, 'Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study', Stroke, vol. 48, no. 3, pp. 726-732. https://doi.org/10.1161/STROKEAHA.116.015770

@article{407af50228504324be87e84e07a1c6b0,

title = "Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study",

abstract = "Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.",

keywords = "atrial fibrillation, myocardial infarction, risk stratification, stroke",

author = "Maurizio Paciaroni and Giancarlo Agnelli and Valeria Caso and Georgios Tsivgoulis and Furie, {Karen L.} and Prasanna Tadi and Cecilia Becattini and Nicola Falocci and Marialuisa Zedde and Abdul-Rahim, {Azmil H.} and Lees, {Kennedy R.} and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D'Amore and Mosconi, {Maria Giulia} and Cimini, {Ludovica Anna} and Antonio Procopio and Paolo Bovi and Monica Carletti and Alberto Rigatelli and Manuel Cappellari and Jukka Putaala and Liisa Tomppo and Turgut Tatlisumak and Fabio Bandini and Simona Marcheselli and Alessandro Pezzini and Loris Poli and Alessandro Padovani and Luca Masotti and Vieri Vannucchi and Sohn, {Sung Il} and Gianni Lorenzini and Rossana Tassi and Francesca Guideri and Maurizio Acampa and Giuseppe Martini and George Ntaios and Efstathia Karagkiozi and George Athanasakis and Kostantinos Makaritsis and Kostantinos Vadikolias and Chrysoula Liantinioti and Maria Chondrogianni and Nicola Mumoli and Domenico Consoli and Franco Galati and Simona Sacco and Antonio Carolei and Cindy Tiseo and Francesco Corea and Walter Ageno and Marta Bellesini and Giovanna Colombo and Giorgio Silvestrelli and Alfonso Ciccone and Umberto Scoditti and Licia Denti and Michelangelo Mancuso and Miriam Maccarrone and Giovanni Orlandi and Nicola Giannini and Gino Gialdini and Tiziana Tassinari and {De Lodovici}, {Maria Luisa} and Giorgio Bono and Christina Rueckert and Antonio Baldi and Sebastiano D'Anna and Danilo Toni and Federica Letteri and Martina Giuntini and Lotti, {Enrico Maria} and Yuriy Flomin and Alessio Pieroni and Odysseas Kargiotis and Theodore Karapanayiotides and Serena Monaco and Baronello, {Mario Maimone} and Laszl{\'o} Csiba and Lilla Szab{\'o} and Alberto Chiti and Elisa Giorli and {Del Sette}, Massimo and Davide Imberti and Dorjan Zabzuni and Boris Doronin and Vera Volodina and Patrik Michel and Peter Vanacker and Kristian Barlinn and Pallesen, {Lars Peder} and Jessica Kepplinger and Ulf Bodechtel and Johannes Gerber and Dirk Deleu and Gayane Melikyan and Faisal Ibrahim and Naveed Akhtar and Vanessa Gourbali and Shadi Yaghi",

year = "2017",

month = mar,

day = "1",

doi = "10.1161/STROKEAHA.116.015770",

language = "English",

volume = "48",

pages = "726--732",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema

T2 - The ALESSA Score Study

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Caso, Valeria

AU - Tsivgoulis, Georgios

AU - Furie, Karen L.

AU - Tadi, Prasanna

AU - Becattini, Cecilia

AU - Falocci, Nicola

AU - Zedde, Marialuisa

AU - Abdul-Rahim, Azmil H.

AU - Lees, Kennedy R.

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D'Amore, Cataldo

AU - Mosconi, Maria Giulia

AU - Cimini, Ludovica Anna

AU - Procopio, Antonio

AU - Bovi, Paolo

AU - Carletti, Monica

AU - Rigatelli, Alberto

AU - Cappellari, Manuel

AU - Putaala, Jukka

AU - Tomppo, Liisa

AU - Tatlisumak, Turgut

AU - Bandini, Fabio

AU - Marcheselli, Simona

AU - Pezzini, Alessandro

AU - Poli, Loris

AU - Padovani, Alessandro

AU - Masotti, Luca

AU - Vannucchi, Vieri

AU - Sohn, Sung Il

AU - Lorenzini, Gianni

AU - Tassi, Rossana

AU - Guideri, Francesca

AU - Acampa, Maurizio

AU - Martini, Giuseppe

AU - Ntaios, George

AU - Karagkiozi, Efstathia

AU - Athanasakis, George

AU - Makaritsis, Kostantinos

AU - Vadikolias, Kostantinos

AU - Liantinioti, Chrysoula

AU - Chondrogianni, Maria

AU - Mumoli, Nicola

AU - Consoli, Domenico

AU - Galati, Franco

AU - Sacco, Simona

AU - Carolei, Antonio

AU - Tiseo, Cindy

AU - Corea, Francesco

AU - Ageno, Walter

AU - Bellesini, Marta

AU - Colombo, Giovanna

AU - Silvestrelli, Giorgio

AU - Ciccone, Alfonso

AU - Scoditti, Umberto

AU - Denti, Licia

AU - Mancuso, Michelangelo

AU - Maccarrone, Miriam

AU - Orlandi, Giovanni

AU - Giannini, Nicola

AU - Gialdini, Gino

AU - Tassinari, Tiziana

AU - De Lodovici, Maria Luisa

AU - Bono, Giorgio

AU - Rueckert, Christina

AU - Baldi, Antonio

AU - D'Anna, Sebastiano

AU - Toni, Danilo

AU - Letteri, Federica

AU - Giuntini, Martina

AU - Lotti, Enrico Maria

AU - Flomin, Yuriy

AU - Pieroni, Alessio

AU - Kargiotis, Odysseas

AU - Karapanayiotides, Theodore

AU - Monaco, Serena

AU - Baronello, Mario Maimone

AU - Csiba, Laszló

AU - Szabó, Lilla

AU - Chiti, Alberto

AU - Giorli, Elisa

AU - Del Sette, Massimo

AU - Imberti, Davide

AU - Zabzuni, Dorjan

AU - Doronin, Boris

AU - Volodina, Vera

AU - Michel, Patrik

AU - Vanacker, Peter

AU - Barlinn, Kristian

AU - Pallesen, Lars Peder

AU - Kepplinger, Jessica

AU - Bodechtel, Ulf

AU - Gerber, Johannes

AU - Deleu, Dirk

AU - Melikyan, Gayane

AU - Ibrahim, Faisal

AU - Akhtar, Naveed

AU - Gourbali, Vanessa

AU - Yaghi, Shadi

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.

AB - Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings.

KW - atrial fibrillation

KW - myocardial infarction

KW - risk stratification

KW - stroke

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UR - http://www.scopus.com/inward/citedby.url?scp=85012195491&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.116.015770

DO - 10.1161/STROKEAHA.116.015770

M3 - Article

AN - SCOPUS:85012195491

SN - 0039-2499

VL - 48

SP - 726

EP - 732

JO - Stroke

JF - Stroke

IS - 3

ER -

Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

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