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. 2025 Sep 29;25(1):195.
doi: 10.1186/s12873-025-01352-3.

Pre-hospital THRIVE score predicts the thrombolysis in cerebral infarction outcome post endovascular thrombectomy: an emergency medical service study

Hui-An Lin  1   2   3 , Sheng-Feng Lin  4   5   6   7   8 , Chyi-Huey Bai  9   10   11
Affiliations

Pre-hospital THRIVE score predicts the thrombolysis in cerebral infarction outcome post endovascular thrombectomy: an emergency medical service study

Hui-An Lin et al. BMC Emerg Med. .

Abstract

Background: The Totaled Health Risks in Vascular Events (THRIVE) score, which ranges from 0 to 9, incorporates factors such as age, the National Institutes of Health Stroke Scale (NIHSS), and the presence of comorbidities including atrial fibrillation, diabetes mellitus, and hypertension. This study aimed to evaluate the predictive value of the THRIVE score on immediate revascularization status following endovascular thrombectomy (IAT).

Methods: This retrospective cohort study utilized data from the ASSST dataset, covering the period from January 1, 2017, to May 31, 2022. Patients with acute ischemic stroke who underwent IAT were included in this analysis. The association between the THRIVE score and recanalization status-assessed using the Thrombosis in Cerebral Ischemia (TICI) scale (grades 2b/3)-was evaluated employing logistic regression models.

Results: A total of 485 participants who received IAT were included in the analysis. Our findings revealed that a lower THRIVE score (OR 1.15, 95% CI 1.01-1.30), male sex (OR 1.81, 95% CI 1.15-2.87), and IAT performed following intravenous thrombolysis (OR 1.72, 95% CI 1.08-2.74) were significantly associated with successful revascularization. Youden's index identified a THRIVE score threshold of < 5 as optimal for predicting outcomes. Patients with a THRIVE score < 5 exhibited a higher likelihood of successful revascularization (OR 1.82, 95% CI 1.10-3.03).

Conclusion: A lower THRIVE score (< 5) is associated with an increased likelihood of successful revascularization following IAT in patients with acute ischemic stroke, particularly among women.

Keywords: Acute ischemic stroke; Recanalization; THRIVE score; Thrombectomy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Joint Institutional Review Board (IRB) of Taipei Medical University (IRB numbers: N202110064). Informed consent was waived by the IRB due to the use of anonymous and deidentified data. In accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study. Flow diagram illustrating the inclusion and exclusion process of study participants. The chart outlines the number of patients assessed for eligibility, reasons for exclusion, and the final cohort included in the analysis
Fig. 2
Fig. 2
Distribution of TICI grades stratified by THRIVE score groups. The figure compares the distribution of final TICI scores between patients with low (THRIVE 0–4) and high (THRIVE 5–9) baseline THRIVE scores. Patients with lower THRIVE scores had a higher proportion of complete reperfusion (TICI 3: 57.3% vs. 51.1%) and lower rates of unsuccessful revascularization (TICI 0–2a: 13.1% vs. 23.4%) compared to those with higher THRIVE scores
Fig. 3
Fig. 3
Optimized threshold of THRIVE score for predicting successful revascularization (TICI 2b–3). Sensitivity, specificity, and Youden’s index are plotted as functions of THRIVE score thresholds. The optimal cutoff of 5.0 maximized Youden’s index, indicating the best trade-off between sensitivity and specificity for predicting TICI 2b–3 reperfusion
Fig. 4
Fig. 4
Receiver of operating characteristic curve of THRIVE score combined with TICI grade for predicting 3-month modified Rankin Scale (mRS) in patients treated at TMUH. The figure compares the predictive performance of THRIVE score < 5, final TICI grade, and a combined model in relation to 90-day functional independence. The area under the curve (AUC) was 0.7362 for the combined model, 0.6845 for THRIVE < 5 alone, and 0.6381 for TICI alone
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