BACKGROUND: : Various tools are currently available to quantify the risks of 
adverse clinical outcomes after an ischemic stroke. This study aimed to validate 
and compare prognostic scales among Chinese patients with ischemic stroke.
METHODS: : We compared three stroke prognostic scales (Stroke Prognostication 
using Age and the National Institutes of Health Stroke Scale-100 [SPAN-100], 
Totaled Health Risks in Vascular Events [THRIVE], and Acute Stroke Registry and 
Analysis of Lausanne [ASTRAL]) in 3870 Chinese patients with ischemic stroke 
from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The 
2-year primary outcome was a combination of death and major disability (modified 
Rankin Scale score ≥3).
RESULTS: : Among all the scales, the ASTRAL score had the best accuracy for 
predicting 2-year prognosis in Chinese patients with ischemic stroke. The 
C-statistic of the ASTRAL score for the 2-year primary outcome was 0.79 (95% 
confidence interval [CI]: 0.78-0.80), and the Hosmer-Lemeshow goodness-of-fit 
test showed that the ASTRAL score fitted Chinese patients with ischemic stroke 
well (χ2 = 9.83, P = 0.277). The incidences of the primary outcome in the <5%, 
5%-9.9%, 10%-19.9%, and ≥20% risk groups based on the ASTRAL scores were 3.93%, 
7.55%, 14.29%, and 41.81%, respectively (odds ratio: 1.23; 95% CI: 1.21-1.26; P 
< 0.001).
CONCLUSION: : The ASTRAL score had higher efficacy than the SPAN-100 and THRIVE 
scores in predicting 2-year adverse outcomes among Chinese patients with 
ischemic stroke, suggesting that it could be a valuable risk assessment tool for 
the 2-year prognosis of such patients.