Koji Tanaka, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Mayank Goyal, Michael D Hill, Bijoy K Menon, Ashutosh P Jadhav, Diogo C Haussen, Sheila C O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, Adnan H Siddiqui, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk
{"title":"HERMES-24评分对大血管闭塞治疗后预后预测的后时间窗验证","authors":"Koji Tanaka, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Mayank Goyal, Michael D Hill, Bijoy K Menon, Ashutosh P Jadhav, Diogo C Haussen, Sheila C O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, Adnan H Siddiqui, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk","doi":"10.1212/WNL.0000000000213796","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.</p><p><strong>Methods: </strong>Data are from the Analysis of Pooled Data from Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well collaboration, a patient-level meta-analysis of 6 randomized trials of EVT beyond 6 hours after last known well, with an enrollment period from September 2014 to March 2019. Patients who were also part of the HERMES collaboration data set were excluded from the analyses. The HERMES-24 score was calculated as the sum of the patient's age/10 and NIH Stroke Scale (NIHSS) score at 24 hours after randomization. The predictive ability of the score for a 90-day outcome (modified Rankin Scale [mRS] scores ≤2 and ≤3, ordinal mRS score, and mortality) was investigated.</p><p><strong>Results: </strong>Among 435 patients (48.5% men, median age 71 years), the median onset-to-randomization time was 654 (interquartile range 516-849) minutes and the median baseline NIHSS score was 16 (interquartile range 13-21). The HERMES-24 score was predictive of 90-day mRS scores ≤2 and ≤3, ordinal mRS score, and mortality in both the EVT arm (n = 223, <i>c</i>-statistic [95% CI] 0.917 [0.875-0.944], 0.895 [0.853-0.938], 0.820 [0.745-0.891], and 0.849 [0.776-0.922], respectively) and the control arm (n = 212, <i>c</i>-statistic [95% CI] 0.921 [0.872-0.969], 0.879 [0.827-0.930], 0.805 [0.746-0.852], and 0.805 [0.738-0.871], respectively).</p><p><strong>Discussion: </strong>The HERMES-24 score was highly predictive of 90-day outcome among patients with stroke due to LVO and small ischemic core for those presenting in the late time window, irrespective of intervention. This score must be further validated in a real-world clinical setting if it is applicable to all patients with LVO admitted in late time windows.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213796"},"PeriodicalIF":7.7000,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window.\",\"authors\":\"Koji Tanaka, Scott Brown, Gregory W Albers, Tudor G Jovin, Maarten G Lansberg, Raul G Nogueira, Mayank Goyal, Michael D Hill, Bijoy K Menon, Ashutosh P Jadhav, Diogo C Haussen, Sheila C O Martins, Leticia C Rebello, Marc Ribo, Aquilla S Turk, Adnan H Siddiqui, David S Liebeskind, Jeremy J Heit, Michael P Marks, Andrew M Demchuk\",\"doi\":\"10.1212/WNL.0000000000213796\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.</p><p><strong>Methods: </strong>Data are from the Analysis of Pooled Data from Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well collaboration, a patient-level meta-analysis of 6 randomized trials of EVT beyond 6 hours after last known well, with an enrollment period from September 2014 to March 2019. Patients who were also part of the HERMES collaboration data set were excluded from the analyses. The HERMES-24 score was calculated as the sum of the patient's age/10 and NIH Stroke Scale (NIHSS) score at 24 hours after randomization. The predictive ability of the score for a 90-day outcome (modified Rankin Scale [mRS] scores ≤2 and ≤3, ordinal mRS score, and mortality) was investigated.</p><p><strong>Results: </strong>Among 435 patients (48.5% men, median age 71 years), the median onset-to-randomization time was 654 (interquartile range 516-849) minutes and the median baseline NIHSS score was 16 (interquartile range 13-21). The HERMES-24 score was predictive of 90-day mRS scores ≤2 and ≤3, ordinal mRS score, and mortality in both the EVT arm (n = 223, <i>c</i>-statistic [95% CI] 0.917 [0.875-0.944], 0.895 [0.853-0.938], 0.820 [0.745-0.891], and 0.849 [0.776-0.922], respectively) and the control arm (n = 212, <i>c</i>-statistic [95% CI] 0.921 [0.872-0.969], 0.879 [0.827-0.930], 0.805 [0.746-0.852], and 0.805 [0.738-0.871], respectively).</p><p><strong>Discussion: </strong>The HERMES-24 score was highly predictive of 90-day outcome among patients with stroke due to LVO and small ischemic core for those presenting in the late time window, irrespective of intervention. This score must be further validated in a real-world clinical setting if it is applicable to all patients with LVO admitted in late time windows.</p>\",\"PeriodicalId\":19256,\"journal\":{\"name\":\"Neurology\",\"volume\":\"105 3\",\"pages\":\"e213796\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2025-08-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1212/WNL.0000000000213796\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/3 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1212/WNL.0000000000213796","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/3 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Validation of the HERMES-24 Score for Outcome Prediction Post Large Vessel Occlusion Treatment in Later Time Window.
Background and objectives: The Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES)-24 score is highly predictive of outcomes after anterior circulation large vessel occlusion (LVO) treatment, irrespective of intervention in the early time window. Recent evidence has further broadened the eligibility of endovascular therapy (EVT) to patients with late presentation or unwitnessed onset including those with stroke-on-awakening. We aimed to investigate the prediction ability of the HERMES-24 score in patients with anterior circulation LVO and small ischemic core presenting in the late time window from last seen normal.
Methods: Data are from the Analysis of Pooled Data from Randomized Studies of Thrombectomy More Than 6 Hours After Last Known Well collaboration, a patient-level meta-analysis of 6 randomized trials of EVT beyond 6 hours after last known well, with an enrollment period from September 2014 to March 2019. Patients who were also part of the HERMES collaboration data set were excluded from the analyses. The HERMES-24 score was calculated as the sum of the patient's age/10 and NIH Stroke Scale (NIHSS) score at 24 hours after randomization. The predictive ability of the score for a 90-day outcome (modified Rankin Scale [mRS] scores ≤2 and ≤3, ordinal mRS score, and mortality) was investigated.
Results: Among 435 patients (48.5% men, median age 71 years), the median onset-to-randomization time was 654 (interquartile range 516-849) minutes and the median baseline NIHSS score was 16 (interquartile range 13-21). The HERMES-24 score was predictive of 90-day mRS scores ≤2 and ≤3, ordinal mRS score, and mortality in both the EVT arm (n = 223, c-statistic [95% CI] 0.917 [0.875-0.944], 0.895 [0.853-0.938], 0.820 [0.745-0.891], and 0.849 [0.776-0.922], respectively) and the control arm (n = 212, c-statistic [95% CI] 0.921 [0.872-0.969], 0.879 [0.827-0.930], 0.805 [0.746-0.852], and 0.805 [0.738-0.871], respectively).
Discussion: The HERMES-24 score was highly predictive of 90-day outcome among patients with stroke due to LVO and small ischemic core for those presenting in the late time window, irrespective of intervention. This score must be further validated in a real-world clinical setting if it is applicable to all patients with LVO admitted in late time windows.
期刊介绍：
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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