THRIVE Score Predicts Ischemic Stroke Outcomes and Thrombolytic Hemorrhage Risk in VISTA
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THRIVE Score Predicts Ischemic Stroke Outcomes
and Thrombolytic Hemorrhage Risk in VISTA
Alexander C. Flint, MD, PhD; Bonnie S. Faigeles, NP, MPH; Sean P. Cullen, MD;
Hooman Kamel, MD; Vivek A. Rao, MD; Rishi Gupta, MD; Wade S. Smith, MD, PhD;
Philip M. Bath, MD, FRCP; Geoffrey A. Donnan, MD; on behalf of the VISTA Collaboration
Background and Purpose—In previous studies, the Totaled Health Risks in Vascular Events (THRIVE) score has shown
broad utility, allowing prediction of clinical outcome, death, and risk of hemorrhage after tissue-type plasminogen
activator (tPA) treatment, irrespective of the type of acute stroke therapy applied to the patient.
Methods—We used data from the Virtual International Stroke Trials Archive to further validate the THRIVE score in a large
cohort of patients receiving tPA or no acute treatment, to confirm the relationship between THRIVE and hemorrhage after
tPA, and to compare the THRIVE score with several other available outcome prediction scores.
Results—The THRIVE score strongly predicts clinical outcome (odds ratio, 0.55 for good outcome [95% CI, 0.53–0.57];
P3366 Stroke December 2013 included for the present analysis if necessary data were available to Table 1. Patient Characteristics compute the THRIVE score, if data were available on functional out- come on the mRS at 3 months, or data were available on mortality by No tPA (n=3326) tPA (n=2398) All (N=5724) P Value 3 months. On the basis of these criteria, data were available from a Age 69.7±12.3 68.1±12.9 69.0±12.6
Flint et al THRIVE Score in VISTA 3367
Table 2. THRIVE Score Components and Outcome
Odds Ratio 95% CI P Value
Model 1: good outcome
Age 0.47 0.43–0.533368 Stroke December 2013
hemorrhagic risk, the HAT score, and superior to the SPAN-
100 (Figure 2C). For the prediction of ICH (parenchymal
hemorrhage type 2 or significant adverse events-hemorrhage)
after tPA, the THRIVE ROC AUC was 0.633 compared with
0.602 for the HAT score (P=0.08; n=1708), and the THRIVE
ROC AUC was 0.653 compared with 0.534 for the SPAN-100
score (PFlint et al THRIVE Score in VISTA 3369
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Disclosures stroke treatment device in the TREVO-2 trial. Stroke. 2013;44:3370–3375.
Data were transmitted in anonymized form from VISTA to Dr Flint, 14. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME,
who designed the present study and performed all statistical analy- et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS)
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boards for Genentech. Dr Bath is a member of the VISTA Executive 15. König IR, Ziegler A, Bluhmki E, Hacke W, Bath PM, Sacco RL, et al; Virtual
Committee. Dr Donnan has served on scientific advisory boards for International Stroke Trials Archive (VISTA) Investigators. Predicting
Boehringer Ingelheim, Sanofi, Bayer, Pfizer, and Amgen. The other long-term outcome after acute ischemic stroke: a simple index works in
authors report no conflicts. patients from controlled clinical trials. Stroke. 2008;39:1821–1826.
Downloaded from http://stroke.ahajournals.org/ by guest on November 1, 2015THRIVE Score Predicts Ischemic Stroke Outcomes and Thrombolytic Hemorrhage Risk
in VISTA
Alexander C. Flint, Bonnie S. Faigeles, Sean P. Cullen, Hooman Kamel, Vivek A. Rao, Rishi
Gupta, Wade S. Smith, Philip M. Bath and Geoffrey A. Donnan
on behalf of the VISTA Collaboration
Stroke. 2013;44:3365-3369; originally published online September 26, 2013;
doi: 10.1161/STROKEAHA.113.002794
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