THRIVE Score Predicts Outcomes With a Third-Generation Endovascular Stroke Treatment Device in the TREVO-2 Trial

• Published in: Stroke (1970) 2013-12, Vol.44 (12), p.3370-3375
• Main Authors: Flint, Alexander C, Xiang, Bin, Gupta, Rishi, Nogueira, Raul G, Lutsep, Helmi L, Jovin, Tudor G, Albers, Gregory W, Liebeskind, David S, Sanossian, Nerses, Smith, Wade S
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Brain Ischemia - drug therapy; Brain Ischemia - surgery; Brain Ischemia - therapy; Combined Modality Therapy; Diseases of the nervous system; Endovascular Procedures - methods; Female; Fibrinolytic Agents - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Neurology; Predictive Value of Tests; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stroke - drug therapy; Stroke - surgery; Stroke - therapy; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.113.002796

BACKGROUND AND PURPOSE—Several outcome prediction scores have been tested in patients receiving acute stroke treatment with previous generations of endovascular stroke treatment devices. The TREVO-2 trial was a randomized controlled trial comparing a novel endovascular stroke treatment device (the Trevo device) to a previous-generation endovascular stroke treatment device (the Merci device). METHODS—We used data from the TREVO-2 trial to validate the Totaled Health Risks in Vascular Events (THRIVE) score in patients receiving treatment with a third-generation endovascular stroke treatment device and to compare THRIVE to other predictive scores. We used logistic regression to model outcomes and compared score performance with receiver operating characteristic curve analysis. RESULTS—In the TREVO-2 trial, the THRIVE score strongly predicts clinical outcome and mortality. The relationship between THRIVE score and outcome is not influenced by either success of recanalization or the type of device used (Trevo versus Merci). The superiority of the Trevo device to the Merci device is evident particularly among patients with a low-to-moderate THRIVE score (0–5; 53.8% good outcome with Trevo versus 27.5% good outcome with Merci). In receiver operating characteristic curve analysis, the THRIVE score was comparable or superior to several other outcome prediction scores (HIAT, HIAT-2, SPAN-100, and iScore). CONCLUSIONS—The THRIVE score strongly predicts clinical outcome and mortality in the TREVO-2 trial. Taken together with THRIVE validation data from patients receiving intravenous tissue-type plasminogen activator or no acute treatment, the THRIVE score has broad predictive power in patients with acute ischemic stroke, which is likely because THRIVE reflects a set of strong nonmodifiable predictors of stroke outcome. A free Web calculator for the THRIVE score is available at http://www.thrivescore.org.