Development and validation of the ANGS score for predicting long-term outcomes in acute ischemic stroke patients receiving intravenous thrombolysis

PURPOSE: To develop and validate a weighted predictive scoring system for identifying poor long-term functional outcomes in acute ischemic stroke (AIS) patients undergoing intravenous thrombolysis (IVT) therapy. METHODS: In this study, we initially conducted a retrospective analysis of a derivation cohort comprising 555 consecutive AIS patients who received IVT treatment. Through multivariable logistic regression analysis, we identified independent predictors of 90-day functional outcomes, which were subsequently utilized to develop a predictive scoring tool (ANGS score). To evaluate its clinical applicability, we performed both retrospective and prospective validations of the ANGS score in independent cohorts. RESULTS: The ANGS score was derived based on four key variables: age, the National Institutes of Health Stroke Scale (NIHSS) score, blood glucose on admission (Glu), and systolic blood pressure (SBP). The model demonstrated strong discriminative capacity across all cohorts, achieving AUC values of 0.803 in the derivation cohort, 0.837 in the retrospective validation cohort (Validation 1), and 0.789 in the prospective validation cohort (Validation 2) for long-term functional outcome prediction. The ANGS score consistently demonstrated as an important predictor of 90-day outcomes in the derivation cohort. Logistic regression analysis revealed a strong, statistically significant association between increasing ANGS scores and poor 90-day mRS outcomes (OR = 3.243, 95% CI: 2.639–3.984; P < 0.001). CONCLUSION: The ANGS score represents a clinically practical and reliable tool for predicting long-term functional outcomes in AIS patients following IVT therapy. This scoring system may enhance clinical decision-making processes and provide valuable prognostic information for healthcare providers, patients, and their families.