London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 311 63 Stroke prognosis Do measures of co-morbidity and frailty add to the prediction of poor outcome after stroke? P. Fearon1, D.J. Stott2, P. Langhorne3 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM1, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM2, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UNITED KINGDOM3 Background Robust case-mix adjustment is essential for comparison of patient outcomes in observational stud-ies. Important case-mix variables for stroke prognosis include age, pre-stroke function and initial stroke severity. We aimed to determine if co-morbidity and frailty have value in case-mix adjust-ment models as independent predictors of early poor outcome after stroke. Methods Consecutive acute stroke admissions from a geographically defined population (East Glasgow, UK) were prospectively recorded between February 2011 and March 2012. Variables including age, pre-stroke modified Rankin Scale (mRS), Charlson co-morbidity index (CCI), Rockwood’s frailty index and baseline National Institute for Health Stroke Scale (NIHSS) were derived from inpatient case-records. We used Mann-Whitney U test and backward elimination logistic regression to iden-tify predictors of: death in hospital, dependency at discharge (dichotomised mRS) and discharge home. Results We recorded 257 acute stroke admissions; mean age 71.9 years (SD13.3); 54% male. Median NI-HSS 4 (range:0-28); median pre-stroke mRS 1 (IQR:0-2). Only 11% (n=29) had no co-morbidity (CCI=0); 45% (n=86) had at least 1 marker of frailty on admission. Inpatient mortality was 12%. In univariate analysis: age, pre-stroke mRS, CCI, frailty and baseline NIHSS were strong predictors of all three outcomes of interest (p<0.005 for all analyses). Variables which remained significant in multivariate analyses were: in-patient death;pre-stroke mRS (p=0.003) and NIHSS (p<0.001): dis-charge mRS 0-2;age, NIHSS, pre-stroke mRS (all p<0.001): discharge home;age (p=0.16), NIHSS (p<0.001) and frailty (p<0.001). Conclusion Frailty and co-morbidity were prevalent in our stroke population. Whilst frailty remained a strong independent predictor of discharge home after stroke in multi-variate analysis, co-morbidity did not remain significant for any outcome. The addition of frailty to existing case-mix adjustment models in stroke should be explored. 64 Stroke prognosis Long-term risk associated with Intracranial Atherosclerosis in patients with acute ischaemic events. C. Ovesen1, A. Abild2, A.F. Christensen3, S. Rosenbaum4, C.K Hansen5, I. Havsteen6, H. Chris-tensen7 Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK1, De-partment of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK2, Department of Radiology, Bispebjerg University Hospital, Copenhagen, DENMARK3, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK4, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK5, Department of Radiology, Bispebjerg University Hospital, , 6, Department of Neurology, Bispebjerg University Hospital, Copenhagen, DENMARK7 Background: Intracranial atherosclerosis represents a potentially modifiable risk factor for recurrent ischemic events. We investigated the long-term risk of recurrent vascular events and death associated to intra-cranial atherosclerosis identified during routine workup. Method: We included Cerebral CT (CT-C) and CT-angiography (CTA) from consecutive patients admitted with acute ischaemic stroke or TIA from April 2009 to December 2011. Intracranial atherosclerosis was defined as intracranial arterial stenosis (IAS) on CTA or intracranial artery calcifications (IAC) on CT-C. Intracranial stenosis was graded into 30-50%, 50-70% and >70% lumen reduction. The extent of IAC was graded as number of vessels affected. Recurrence (stroke, ischemic heart disease (IHD), TIA) was documented through the national online chart system; Poor outcome was defined as recurrent event or death. Patients were followed-up until August 2012. Results: 652 patients with final diagnosis of ischaemic stroke or TIA patients were included. IAS was present in 115 patients (71; 30-50%, 29; 50-70%, 15; >70%). 215 (33%) patients had no IAC, 337 (52%) had IAC in 1-2 vessels and 100 (15%) in >2 vessels. Median (range) follow-up time was 623 (238- 1192) days. During this time 43 strokes, 15 TIA and 12 IHD occurred, and 50 patients died. A signif-icant difference in risk of poor outcome was present when stratified for different degrees of IAS and IAC respectively (Log-rank test P<0.01 for both). In Cox regression model, non-adjusted estimates of IAS and IAC were associated with recurrent ischemic event and poor outcome. When adjusted for age, NIHSS, atrial fibrillation and prestroke ability, IAS (>30%) emerged as an independent risk factor for recurrent event (HR 1.84; CI: 1.06-3.19). Conclusion: Intracranial atherosclerosis detected during acute radiological imaging can be used to stratify the risk of recurrent event. The IAS (>30%) is an independent risk factor for recurrent events.
Karger_ESC London_2013
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