BACKGROUND AND PURPOSE: The ASTRAL score was recently introduced as a prognostic 
tool for acute ischemic stroke. It predicts 3-month outcome reliably in both the 
derivation and the validation European cohorts. We aimed to validate the ASTRAL 
score in a Chinese stroke population and moreover to explore its prognostic 
value to predict 12-month outcome.
METHODS: We applied the ASTRAL score to acute ischemic stroke patients admitted 
to 132 study sites of the China National Stroke Registry. Unfavorable outcome 
was assessed as a modified Rankin Scale score >2 at 3 and 12 months. Areas under 
the curve were calculated to quantify the prognostic value. Calibration was 
assessed by comparing predicted and observed probability of unfavorable outcome 
using Pearson correlation coefficient.
RESULTS: Among 3755 patients, 1473 (39.7%) had 3-month unfavorable outcome. 
Areas under the curve for 3 and 12 months were 0.82 and 0.81, respectively. 
There was high correlation between observed and expected probability of 
unfavorable 3- and 12-month outcome (Pearson correlation coefficient: 0.964 and 
0.963, respectively).
CONCLUSIONS: ASTRAL score is a reliable tool to predict unfavorable outcome at 3 
and 12 months after acute ischemic stroke in the Chinese population. It is a 
useful tool that can be readily applied in clinical practice to risk-stratify 
acute stroke patients.