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The Essen Stroke Risk Score (ESRS) estimates the long-term risk of recurrent stroke in patients with a history of ischemic stroke or TIA. Points are awarded for age, hypertension, diabetes, prior myocardial infarction, other cardiovascular disease, peripheral arterial disease, smoking, and prior ischemic events; the total ranges 0–9.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
The Essen Stroke Risk Score was developed from the CAPRIE trial cohort of patients with prior ischemic events to predict the risk of recurrent ischemic stroke and to identify patients who might benefit from more intensive antiplatelet or antithrombotic therapy. Points are assigned for age 65–75 (1) and > 75 (2), hypertension, diabetes, prior myocardial infarction, other cardiovascular disease (excluding myocardial infarction and atrial fibrillation), peripheral arterial disease, smoking, and a prior ischemic stroke or TIA. Scores of 3 or more are considered high risk.
Specialty
NeurologyCategory
NeurologyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-16
Formula
Keywords
Normal Range
0–9. Scores of 0–2 indicate low risk; 3 or more indicate high risk of recurrent ischemic stroke and warrant aggressive secondary prevention.
| Classification | Range |
|---|---|
Low risk Lower long-term recurrent stroke risk | 0–2 |
High risk Higher recurrent stroke risk; aggressive secondary prevention | 3–9 |
Estimates the long-term risk of recurrent ischemic stroke in patients with prior ischemic stroke or TIA using age, hypertension, diabetes, prior myocardial infarction, other cardiovascular disease, peripheral arterial disease, smoking, and prior ischemic events, producing a total of 0–9.
The Essen Stroke Risk Score adds an age score (0 under 65, 1 for 65-75, 2 over 75) to one point each for hypertension, diabetes, prior myocardial infarction, other cardiovascular disease, peripheral arterial disease, current smoking, and prior ischemic stroke or TIA, for a total of 0-9.
Age category scored 0 (under 65 years), 1 (65-75 years), or 2 (over 75 years).
History of hypertension; Yes adds one point.
History of diabetes; Yes adds one point.
Previous myocardial infarction; Yes adds one point.
Other cardiovascular disease excluding MI and atrial fibrillation; Yes adds one point.
Peripheral arterial disease; Yes adds one point.
Current cigarette smoking; Yes adds one point.
Previous ischemic stroke or transient ischemic attack; Yes adds one point.
Scores of 0–2 indicate low long-term recurrent stroke risk; scores of 3–9 indicate high risk and warrant aggressive secondary prevention. In patients with atrial fibrillation, use AF-specific tools (e.g., CHA2DS2-VASc) for anticoagulation decisions.
The ESRS supports long-term secondary prevention decisions by quantifying recurrent stroke risk, guiding the intensity of antiplatelet therapy and vascular risk-factor management.
A 78-year-old hypertensive diabetic patient with a prior myocardial infarction and a recent minor ischemic stroke continues to smoke.
Inputs:
Expected Result: ESRS 7/9 — HIGH recurrent stroke risk; aggressive secondary prevention warranted.
A score of 3 or more indicates high recurrent stroke risk and justifies aggressive secondary prevention.
No — CHA2DS2-VASc is for stroke risk in atrial fibrillation; ESRS is for recurrent stroke risk after an ischemic event.
Acute TIA triage
Deficit quantification
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. The ESRS supports risk stratification; treatment decisions must follow current clinical guidelines and individual patient circumstances.