Article Figures & Data
- Figure 1
The D2H2A nomogram for SIT within 1 year in sICAS patients receiving optimal medical treatment. To use the D2H2A nomogram, for instance, a 60-year-old (3 points) sICAS patient with a history of hypertension (1 point) and intermediate haemodynamic status of sICAS (7 points) would have 11 points in the D2H2A nomogram, and hence a 5.0% probability of having SIT within 1 year under contemporarily optimal medical treatment. sICAS, symptomatic intracranial atherosclerotic stenosis; SIT, recurrent ischaemic stroke in the same territory.
- Figure 2
Calibration plot of the D2H2A nomogram for recurrent ischaemic stroke in the same territory within 1 year.
- Figure 3
DCA for the three nomograms. The DCA shows the net benefits (y axis) of nomograms to stratify subjects for the risk of an outcome across a range of threshold probabilities of the outcome (x axis). (A) The reference lines (grey and black dashed lines) assume no patient or all patients will have an SIT. The grey and black solid lines illustrate the net benefits of nomograms I and D2H2A in risk stratification of sICAS patients, across a range of threshold probabilities of 1 year SIT (x axis). With an 8% risk of SIT in the study population (red dashed line), nomograms I and D2H2A, respectively, yielded a net benefit of 0.021 and 0.031, suggesting that the D2H2A nomogram would identify 10 more patients at risk of SIT within 1 year per 1000 patients, compared with nomogram I. (B) Similarly, nomograms II and D2H2A, respectively, yielded a net benefit of 0.020 and 0.031, suggesting that the D2H2A nomogram would identify 11 more patients at risk of SIT within 1 year per 1000 patients, compared with nomogram II. DCA, decision curve analysis; sICAS, symptomatic intracranial atherosclerotic stenosis; SIT, recurrent ischaemic stroke in the same territory.
- Table 1
Baseline characteristics of the patients
Characteristics Overall
N=245Primary outcome: recurrent ischaemic stroke in the same territory P value Yes
(n=20)No
(n=225)Age, years 0.748 <50 38 (15.5) 2 (10.0) 36 (16.0) ≥50 207 (84.5) 18 (90.0) 189 (84.0) Sex 0.898 Female 89 (36.3) 7 (35.0) 82 (36.4) Male 156 (63.7) 13 (65.0) 143 (63.6) Conventional vascular risk factors Current smoking 98 (40.0) 8 (40.0) 90 (40.0) 1.000 Hypertension 168 (68.6) 16 (80.0) 152 (67.6) 0.251 Diabetes 85 (34.7) 10 (50.0) 75 (33.3) 0.133 Dyslipidaemia 135 (55.1) 15 (75.0) 120 (53.3) 0.062 Prior ischaemic stroke/TIA 37 (15.1) 5 (25.0) 32 (14.2) 0.198 Mean blood pressure at admission, mm Hg* 0.688 <110 133 (54.3) 10 (50.0) 123 (54.7) ≥110 112 (45.7) 10 (50.0) 102 (45.3) Interval from symptom onset to CTA, days 6 (3–11) 5 (3–16) 6 (3–11) 0.453 Severity of luminal stenosis in sICAS 0.688 Moderate (50%–69%) 133 (54.3) 10 (50.0) 123 (54.7) Severe (70%–99%) 112 (45.7) 10 (50.0) 102 (45.3) Haemodynamic status of sICAS 0.004 Normal 101 (41.2) 3 (15.0) 98 (43.5) Intermediate 104 (42.5) 10 (50.0) 94 (41.8) Abnormal 40 (16.3) 7 (35.0) 33 (14.7) Anterior-circulation sICAS 191 (78.0) 18 (90.0) 173 (76.9) 0.261 Leptomeningeal collateral status in patients with anterior-circulation sICAS† 0.065 Good 69 (38.1) 10 (58.8) 59 (36.0) Poor 112 (61.9) 7 (41.2) 105 (64.0) *Mean blood pressure was estimated as 1/3 systolic blood pressure plus 2/3 diastolic blood pressure.
†Leptomeningeal collateral status was assessed in 181 patients among the overall 191 patients with anterior-circulation sICAS.
CTA, CT angiography; sICAS, symptomatic intracranial atherosclerotic stenosis; TIA, transient ischaemic attack.
- Table 2
Logistic regression analyses of the primary outcome
Variables Univariate Multivariate* OR 95% CI P value OR 95% CI P value Age ≥50 years 1.71 0.38 to 7.71 0.482 Male 1.07 0.41 to 2.78 0.898 Current smoking 1.00 0.39 to 2.54 1.000 Hypertension 1.92 0.62 to 5.95 0.258 Diabetes 2.00 0.80 to 5.02 0.139 Dyslipidaemia 2.63 0.92 to 7.47 0.070 2.97 1.02 to 8.65 0.047 Prior ischaemic stroke/TIA 2.01 0.68 to 5.91 0.205 Mean blood pressure at admission ≥110 mm Hg 1.21 0.48 to 3.01 0.688 Interval from symptom onset to CTA, days 0.99 0.95 to 1.04 0.747 Severe luminal stenosis in sICAS (70%–99%) 1.21 0.48 to 3.01 0.688 Haemodynamic status of sICAS Normal Ref. Ref. Intermediate 3.48 0.93 to 13.02 0.065 3.52 0.93 to 13.27 0.063 Abnormal 6.93 1.69 to 28.35 0.007 7.88 1.89 to 32.87 0.005 *Variables with p<0.1 in univariate logistic regression were included in the multivariate analysis.
CTA, CT angiography; sICAS, symptomatic intracranial atherosclerotic stenosis; TIA, transient ischaemic attack.
- Table 3
Comparison of nomograms in risk reclassification
Nomograms Continuous NRI, % Categorical NRI, % IDI, % Estimate (95% CI) P value Estimate (95% CI) P value Estimate (95% CI) P value Comparison 1 Nomogram I: conventional vascular risk factors only* Ref. <0.001 Ref. 0.015 Ref. 0.009 Nomogram III: the D2H2A nomogram† 70.89 (30.84 to 110.94) 25.11 (4.83 to 45.39) 5.18 (1.29 to 9.08) Comparison 2 Nomogram II: conventional vascular risk factors* + severity of luminal stenosis in sICAS Ref. <0.001 Ref. 0.015 Ref. 0.014 Nomogram III: the D2H2A nomogram† 71.56 (29.52 to 113.59) 25.11 (4.83 to 45.39) 4.73 (0.96 to 8.5) *Conventional vascular risk factors included age ≥50 years, diabetes, dyslipidaemia and hypertension.
†The D2H2A nomogram incorporated diabetes, dyslipidaemia, haemodynamic status of sICAS, hypertension and age ≥50 years.
IDI, integrated discrimination improvement; NRI, net reclassification improvement; sICAS, symptomatic intracranial atherosclerotic stenosis.
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