Clinical and imaging data at 5 days as a surrogate for 90-day outcome in ischemic stroke

Karen C. Johnston, Kevin M. Barrett, Yong Hong Ding, Douglas P. Wagner

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Background and Purpose - A simple, easily measured surrogate outcome measure for use in early treatment trials for acute ischemic stroke therapies would be highly valued. We hypothesized that day-5 NIH stroke scale score (NIHSS) and day-5 diffusion weighted imaging (DWI) volume would predict clinical outcome better than either alone and could be considered as a possible surrogate outcome in early phase acute stroke trials. Methods - The prospective Acute Stroke Accurate Prediction (ASAP) trial included a prespecified subgroup evaluated for early outcome. Logistic regression analysis was used to assess the prediction of modified Rankin (mRankin) of 0 or 1. Results - A total of 204 subjects completed the substudy, and 116 (57%) had excellent outcome at 3 months. The area under the ROC curve (AUC) for day-5 NIHSS predicting 3-month excellent outcome was 0.84; for DWI volume predicting outcome was 0.76, and for the multivariable model combining both was 0.84. Conclusions - The results of the early outcome substudy of the ASAP trial suggest that early stroke severity and infarct volume measures are predictive of 3-month excellent outcome. In our data set the DWI volume does not add clinically relevant information in predicting 3-month outcome. Validation of these results is required.

Original languageEnglish (US)
Pages (from-to)1332-1333
Number of pages2
Issue number4
StatePublished - Apr 1 2009


  • Cerebral ischemia
  • Models
  • Prognosis
  • Statistical
  • Stroke outcome
  • Surrogate

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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