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Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke

Kim, Seong Hwan ; Jeon, Eun-Tae ; Yu, Sungwook ; [et al.]

Elsevier BV ; 2021

In: Journal of the Neurological Sciences Vol. 429 ( 2021-10), p. 118754-

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In: Journal of the Neurological Sciences, Elsevier BV, Vol. 429 ( 2021-10), p. 118754-

Type of Medium: Online Resource

ISSN: 0022-510X

URL: Article

DOI: 10.1016/j.jns.2021.118754

Language: English

Publisher: Elsevier BV

Publication Date: 2021

detail.hit.zdb_id: 1500645-1

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Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke

Kim, Seong-Hwan ; Jeon, Eun-Tae ; Yu, Sungwook ; [et al.]

Springer Science and Business Media LLC ; 2021

In: Scientific Reports Vol. 11, No. 1 ( 2021-10-18)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2021-10-18)

Abstract: We aimed to develop a novel prediction model for early neurological deterioration (END) based on an interpretable machine learning (ML) algorithm for atrial fibrillation (AF)-related stroke and to evaluate the prediction accuracy and feature importance of ML models. Data from multicenter prospective stroke registries in South Korea were collected. After stepwise data preprocessing, we utilized logistic regression, support vector machine, extreme gradient boosting, light gradient boosting machine (LightGBM), and multilayer perceptron models. We used the Shapley additive explanation (SHAP) method to evaluate feature importance. Of the 3,213 stroke patients, the 2,363 who had arrived at the hospital within 24 h of symptom onset and had available information regarding END were included. Of these, 318 (13.5%) had END. The LightGBM model showed the highest area under the receiver operating characteristic curve (0.772; 95% confidence interval, 0.715–0.829). The feature importance analysis revealed that fasting glucose level and the National Institute of Health Stroke Scale score were the most influential factors. Among ML algorithms, the LightGBM model was particularly useful for predicting END, as it revealed new and diverse predictors. Additionally, the effects of the features on the predictive power of the model were individualized using the SHAP method.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-021-99920-7

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2021

detail.hit.zdb_id: 2615211-3

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3

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Corrigendum to “D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation” [Thromb. Res. 229 (2023) 219–224]

Nam, Ki-Woong ; Kim, Chi Kyung ; Yu, Sungwook ; [et al.]

Elsevier BV ; 2024

In: Thrombosis Research Vol. 233 ( 2024-01), p. 173-

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In: Thrombosis Research, Elsevier BV, Vol. 233 ( 2024-01), p. 173-

Type of Medium: Online Resource

ISSN: 0049-3848

URL: Article

DOI: 10.1016/j.thromres.2023.11.001

Language: English

Publisher: Elsevier BV

Publication Date: 2024

detail.hit.zdb_id: 1500780-7

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4

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Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke

Eun, Mi-Yeon ; Kim, Jae-Young ; Hwang, Yang-Ha ; [et al.]

Korean Stroke Society ; 2021

In: Journal of Stroke Vol. 23, No. 1 ( 2021-01-31), p. 113-123

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In: Journal of Stroke, Korean Stroke Society, Vol. 23, No. 1 ( 2021-01-31), p. 113-123

Abstract: Background and Purpose To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF).Methods Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION] ) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered.Results Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI] , 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups.Conclusions ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.

Type of Medium: Online Resource

ISSN: 2287-6391 , 2287-6405

URL: Article

DOI: 10.5853/jos.2020.03440

Language: English

Publisher: Korean Stroke Society

Publication Date: 2021

detail.hit.zdb_id: 2814366-8

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5

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D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation

Nam, Ki-Woong ; Kim, Chi Kyung ; Yu, Sungwook ; [et al.]

Elsevier BV ; 2023

In: Thrombosis Research Vol. 229 ( 2023-09), p. 219-224

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In: Thrombosis Research, Elsevier BV, Vol. 229 ( 2023-09), p. 219-224

Type of Medium: Online Resource

ISSN: 0049-3848

URL: Article

DOI: 10.1016/j.thromres.2023.07.014

Language: English

Publisher: Elsevier BV

Publication Date: 2023

detail.hit.zdb_id: 1500780-7

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6

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Pre-Admission CHADS〈sub〉2〈/sub〉 and CHA〈sub〉2〈/sub〉DS〈sub〉2〈/sub〉-VASc Scores on Early Neurological Worsening

Nam, Ki-Woong ; Kim, Chi Kyung ; Yu, Sungwook ; [et al.]

S. Karger AG ; 2021

In: Cerebrovascular Diseases Vol. 50, No. 3 ( 2021), p. 288-295

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In: Cerebrovascular Diseases, S. Karger AG, Vol. 50, No. 3 ( 2021), p. 288-295

Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Stroke risk scores (CHADS 〈 sub 〉 2 〈 /sub 〉 and CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS 〈 sub 〉 2 〈 /sub 〉 and CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04–1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc (aOR = 1.20, 95% CI = 1.04–1.38) and CHADS 〈 sub 〉 2 〈 /sub 〉 scores (aOR = 1.24, 95% CI = 1.01–1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 High CHA 〈 sub 〉 2 〈 /sub 〉 DS 〈 sub 〉 2 〈 /sub 〉 -VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.

Type of Medium: Online Resource

ISSN: 1015-9770 , 1421-9786

URL: Article

DOI: 10.1159/000513396

Language: English

Publisher: S. Karger AG

Publication Date: 2021

detail.hit.zdb_id: 1482069-9

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7

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Abstract TP519: The Effect of Different Oral Anticoagulants on Vascular Outcomes in Stroke With Atrial Fibrillation: A Real-world Data

Seo, Woo-Keun ; Kim, Joon-Tae ; Chung, Jong-Won ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2019

In: Stroke Vol. 50, No. Suppl_1 ( 2019-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)

Abstract: Background and Purpose: Little is known about the different effect of outcomes and factors associated with vascular outcomes in stroke patients with atrial fibrillation in real world practice setting especially in Korea. In this study, we investigated the effect of each oral anticoagulants on vascular outcomes using K-ATTENTION (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts) study. Methods: Consecutive data of acute stroke patients with atrial fibrillation were collected from 11 centers in Korea from January 2013 to December 2015. Eligibility of inclusion was acute stroke within 7 days from the onset of stroke and diagnosis of non-valvular or valvular atrial fibrillation. Vascular outcomes included ischemic stroke, hemorrhagic stroke, death of any cause, and major adverse cerebro/cardiovascular events (MACE). To describe the effect of each oral anticoagulants on vascular outcomes, we performed time-dependent Cox’s regression analyses with the class of oral anticoagulant as a time dependent covariate. For stroke, hemorrhagic stroke, and any stroke, death was considered as competing risk. Results: Among 3213 stroke patients included in K-ATTENTION study, a total 3033 stroke patients (mean age 73.45 ± 9.93 years old, female 48.5%) were included. Mean CHA2DS2-VASc score was 4.89 ± 1.37. During the study period, a total of 161 ischemic strokes, 46 hemorrhagic strokes, 199 any strokes, 556 death and 720 MACE were captured. Time-dependent Cox’s regression analysis revealed that use of oral anticoagulants [vitamin K antagonist (VKA), dabigatran, rivaroxaban, or apixaban] was associated with significantly lower risk of death and MACE compared with no oral anticoagulants use. Although, there was no difference among oral anticoagulants for ischemic stroke, hemorrhagic stroke, or any stroke when compared with no oral anticoagulants, dabigatran showed a trend of reduced risk of any stroke (HR 0.48, 95%CI 0.23 - 1.01, p = 0.0545). Conclusion: This real-world data revealed that the use of oral anticoagulants was associated with the reduced risk of MACE and death. However, for ischemic stroke and hemorrhagic stroke, the results were not conclusive. Dabigatran showed a trend of reduced risk of any stroke.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.50.suppl_1.TP519

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2019

detail.hit.zdb_id: 1467823-8

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8

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Abstract TP435: Oral Anticoagulant Therapy Adherent to ESC Guidelines Reduces the Risk of Recurrent Stroke in Patients With Atrial Fibrillation

Eun, Mi-Yeon ; Hwang, Yang-Ha ; Park, Man-Seok ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2020

In: Stroke Vol. 51, No. Suppl_1 ( 2020-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)

Abstract: Introduction: Oral anticoagulant therapy is the primary treatment for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Early anticoagulant therapy can be beneficial for the prevention of recurrent ischemic stroke, however, also can provoke symptomatic intracranial hemorrhage. This study aims to evaluate the efficacy and safety of standard oral anticoagulant therapy adherent to the European Society of Cardiology (ESC) guidelines compared to early oral anticoagulant therapy. Methods: Acute ischemic stroke patients with AF were included from a nationwide multicenter registry (K-ATTENTION). The primary outcome was recurrent all-type stroke during 90 days of follow-up. Secondary outcomes were major adverse cardiovascular events (MACE), ischemic stroke, intracranial hemorrhage, acute coronary syndrome, all-cause death, and major hemorrhage. The propensity score was used to match the baseline characteristics between the two treatment groups. Results: Among 2,321 eligible patients, 532 patients with standard anticoagulation were matched to 532 patients with early anticoagulation. Eight participants (1.5%) with standard anticoagulation had recurrence of all-type stroke compared with 19 (3.5%) of participants with early anticoagulation (odds ratio [OR], 0.41; 95% confidence interval [CI] , 0.18-0.95; P=0.038). Standard anticoagulation was also associated with reduced risk of recurrent ischemic stroke (OR, 0.30; 95% CI, 0.11-0.82; P=0.019). Other secondary outcomes, including intracranial hemorrhage and major hemorrhage, appeared not to be informative. Conclusions: In conclusion, standard oral anticoagulant therapy adherent to ESC guidelines reduces the risk of recurrent all-type stroke and ischemic stroke compared to early oral anticoagulant therapy.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.51.suppl_1.TP435

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2020

detail.hit.zdb_id: 1467823-8

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9

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Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation

Park, Jong-Ho ; Chung, Jong-Won ; Bang, Oh Young ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Stroke Vol. 52, No. 5 ( 2021-05), p. 1662-1672

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 5 ( 2021-05), p. 1662-1672

Abstract: Data on the effect on vascular outcomes of concomitant atherosclerotic vascular disease (ASVD) with atrial fibrillation (AF) after stroke are limited. This study evaluated the effect of ASVD with AF versus AF only on the risk of vascular events. Methods: We retrospectively analyzed a prospectively registered multicenter database involving 3213 stroke patients with AF. ASVD included extracranial atherosclerosis measured in the proximal portion of the internal carotid artery, intracranial atherosclerosis (all ≥50% stenosis), coronary artery disease, and peripheral artery disease and was categorized into 4 strata depending on the number of ASVDs (0, 1, 2, and 3–4). The independent associations of ASVD with major adverse cardiovascular events, stroke, and all-cause death were assessed. Results: A total of 2670 patients were included (mean age, 73.5±9.8 years; median CHA 2 DS 2 -VASc score, 5; interquartile range, 4−6). During the follow-up (mean, 1.7 years), a total of 672 (25.2%) major adverse cardiovascular events, 170 (6.4%) stroke events, and 501 (18.8%) all-cause deaths were noted. The adjusted hazard ratio for major adverse cardiovascular events versus no ASVD was 1.25 (95% CI, 1.00–1.56) for ASVD 1, 1.34 (95% CI, 1.02–1.76) for ASVD 2, and 1.93 (95% CI, 1.24–2.99) for ASVD 3–4. The adjusted hazard ratio for all-cause death versus no ASVD was 1.32 (1.01–1.74), 1.47 (1.06–2.03), and 2.39 (1.47–3.89), respectively. Among ASVD components, the presence of symptomatic or asymptomatic extracranial atherosclerosis was a more potent predictor of major adverse cardiovascular events (1.27 [1.05–1.54]) and all- cause death (1.45 [1.17–1.81]). Conclusions: ASVD burden with AF can be a cumulative marker of a high risk for untoward vascular outcomes. Among ASVD components, extracranial atherosclerosis seems to have a predominant effect.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.120.032232

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 1467823-8

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10

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Elevated troponin levels are associated with early neurological worsening in ischemic stroke with atrial fibrillation

Nam, Ki-Woong ; Kim, Chi Kyung ; Yu, Sungwook ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Scientific Reports Vol. 10, No. 1 ( 2020-07-28)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-07-28)

Abstract: Serum cardiac troponin I (cTnI) is often elevated in patients with ischemic stroke, and is associated with their prognosis. Since cTnI is also closely related to atrial fibrillation (AF), cTnI may be a sensitive prognostic indicator in patients with AF-related stroke. This study aimed to evaluate the association between serum cTnI and early neurological deterioration (END) in patients with AF-related stroke. We included consecutive AF-related stroke patients between 2013 and 2015. END was defined as an increase ≥ 2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. A total of 1,133 patients with AF-related stroke were evaluated. In multivariable analysis, cTnI [adjusted odds ratio (aOR) = 1.16, 95% confidence interval (CI) 1.00–1.34; P = 0.047] remained significant after adjusting for confounders. Initial NIHSS score (aOR = 1.03, 95% CI 1.00–1.06; P = 0.043) was also positively associated with END; meanwhile, the use of anticoagulants was negatively associated in both vitamin K antagonists (aOR = 0.35, 95% CI 0.23–0.54; P 〈 0.001) and new oral anticoagulants (aOR = 0.41, 95% CI 0.19–0.89; P = 0.024). In conclusion, higher serum cTnI was associated with END in patients with AF-related stroke.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-020-69303-5

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2615211-3

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