Web-Based Tool Helps Predict Risk of Second Stroke

Participants gave information about their medical history and underwent brain scans. After a three-month follow up involving 806 of the participants, 60 second-strokes had occurred; of those, 30 strokes occurred within 14 days of the first stroke. The researchers then used the accumulated data to develop the Recurrence Risk Estimator at 90 days (RRE-90) score to calculate a person's risk of having another stroke within three months by looking at risk factors of stroke, such as history of mini-stroke, transient ischemic attack (TIA), age, and the type of first stroke the person experienced, along with information from brain scans. The higher the score, the higher the likelihood the patient would experience a second stroke.

The researchers found that the 90-day risk was approximately 40 times greater in people with four or more stroke risk factors than in people without any risk factors; the risk of recurrent stroke was 2.6% at 14 days and 6% at 90 days. Over 96 percent of patients who developed a second stroke showed signs of one or more risk factor. The RRE-90 score demonstrated adequate calibration and good discrimination, which was maintained when the test was applied to a separate cohort of 433 patients; the model's performance was also maintained for predicting early (14-day) risk of recurrence. Another interesting study finding was that long-term predictors of stroke, such as smoking, diabetes, and hypertension did not predict short-term strokes. The study was published in the December 16, 2009, online issue of Neurology.

"This is an important new tool because studies show that people who have a second stroke soon after a first stroke are more likely to die or have severe disability,” said lead author Hakan Ay, M.D., of the stroke service at the MGH department of neurology. "This tool can help doctors identify people who are at high risk of having another stroke and need immediate evaluation based on information typically available at the time of initial evaluation.”

The RRE-90 test is freely available for use to help doctors stratify patients presenting with ischemic stroke according to early risk of recurrent stroke.

Related Links:
Massachusetts General Hospital
Harvard Medical School
RRE-90 test