New Stroke Prognostic Score Combines Vascular Aging with Clinical Severity

A newly published study in Neurological Sciences proposes a novel prognostic tool for acute ischemic stroke, integrating vascular aging into risk assessment. The authors evaluated how arterial stiffness measures contribute to predicting functional outcomes and developed a score combining traditional clinical severity with vascular metrics. SpringerLink

The research cohort included 2,730 patients (mean age 72.0 ± 14.4 years) who had undergone 24‑hour blood pressure monitoring after stroke onset. SpringerLink From these data, investigators derived three indices of vascular aging: estimated pulse wave velocity (ePWV), an early vascular aging ambulatory score (EVAAs), and 24‑hour pulse pressure (24 h‑PP). The primary outcome was the proportion of patients with poor functional recovery (modified Rankin Scale > 2) at three months. SpringerLink

Among the vascular metrics, ePWV emerged as the strongest predictor, with an area under the curve (AUC) of 0.77 (95% CI: 0.74–0.79). The optimal cutoff to identify patients at risk of poor outcome was 12.2 m/s, corresponding to 79.4% sensitivity and 61.7% specificity. EVAAs and 24 h‑PP had lower discriminative performance (AUCs, sensitivities, specificities) in this context. SpringerLink

To harness both stroke severity and vascular aging, the authors introduced the “Severity and Arterial Stiffness” (SASt) score, defined simply as NIHSS + 2 × ePWV. This composite score demonstrated superior predictive accuracy, achieving an AUC of 0.87 (95% CI: 0.85–0.88) for three‑month poor functional outcome. SpringerLink

The study’s findings emphasize the prognostic importance of vascular aging in stroke. Incorporating ePWV into risk stratification may capture residual vascular risk not accounted for by conventional clinical metrics. The SASt score offers a straightforward, clinically feasible addition to existing models. However, as the authors note, prospective validation in independent cohorts is necessary before the score can be recommended for routine use.