London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 321 79 Stroke prognosis Intracranial Large Artery Disease is an independent predictor of recurrent vascular events following ischemic stroke in ethnic South Asians. R.S. SHEKHAWAT1, F.P. Woon2, M.C. Wong3, H.M. Chang4, D.A. De Silva5 SINGAPORE GENERAL HOSPITAL, SINGAPORE, SINGAPORE1, SINGAPORE GEN-ERAL HOSPITAL, SINGAPORE, SINGAPORE2, NATIONAL UNIVERSITY OF SINGAPORE, SINGAPORE, SINGAPORE3, NATIONAL NEUROSCIENCE INSTITUTE, SINGAPORE, SIN-GAPORE4, NATIONAL NEUROSCIENCE INSTITUTE, SINGAPORE, SINGAPORE5 Introduction: Intracranial large arteries are the most common site of disease in ischemic stroke among ethnic South Asians who number more than 1 billion worldwide with a wide diaspora. In-tracranial large artery disease (ICLAD) is associated with a high incidence of recurrent stroke in ethnic Chinese and Caucasians. There are no published studies on the natural history of ethnic South Asians with ICLAD. We investigated the association of ICLAD with recurrent vascular events and functional outcome following ischemic stroke in ethnic South Asians. Method: In this prospective study of ethnic South Asians admitted for ischemic stroke, ICLAD was assessed by pre-specified criteria on Magnetic Resonance Angiography or Transcranial Doppler. Telephone follow up was performed at 6 months to assess for vascular events (recurrent stroke, myocardial infarction and vascular death) and poor functional outcome (modified Rankin score >2). Results: Among the 240 South Asian patients recruited, 216 had ICLAD assessment, of which 202 (93%) follow-up data. The prevalence of ICLAD was 51% (105/202). A higher proportion of pa-tients with ICLAD had a recurrent vascular event (12.4% vs. 3.1%, p=0.018) and poor outcome at 6 months (32.1% vs. 13.9%, p=0.002), compared to those without ICLAD. In regression analyses with age, gender, hypertension, diabetes, hyperlipidaemia, ischemic heart disease and atrial fibrilla-tion as covariates, ICLAD was associated with a higher likelihood of recurrent vascular events (OR 3.87, 95% CI 1.02-14.75) and poor outcome (OR 3.80, 95% CI 1.76-8.20). Conclusion: ICLAD is a predictor of recurrent vascular events and poor functional outcome follow-ing ischemic stroke in South Asians, independent of demographics and vascular risk factors. South Asian stroke patients with ICLAD are thus a potential target for trials of aggressive secondary stroke prevention, specific ICLAD management and acute stroke treatments aiming to improve functional outcome. 80 Stroke prognosis Stroke recurrence and long-term outcome in Japanese minor stroke with atrial fibrillation and large artery atherosclerosis ~ Fukuoka Stroke Registry ~ S. Fujimoto1, S. Mezuki2, T. Matsuki3, J. Jinnouchi4, T. Ishitsuka5, T. Kitazono6 Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN1, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN2, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN3, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN4, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, JAPAN5, Department of Medicine and Clini-cal Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JAPAN6 Background & Purpose: Atrial fibrillation (AF) and large artery atherosclerosis (LAA) can be asso-ciated with a bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or LAA. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 3725 patients with acute ischemic stroke with the initial NIH stroke scale score of 7 or less and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. In accordance with AF and intracranial or extracranial LAA (stenosis of 50% or more in diameter), they were classified into 4 groups: patients without both AF and LAA (Group A, n=2154), patients with only AF (Group B, n=475), patients with only LAA (Group C, n=937), and patients with both AF and LAA (Group D, n=159). We observed stroke recurrence and outcome during one year. Results: On the multivariate analysis, age (OR, 0.94; 95%CI 0.93~0.95), initial NIH stroke scale score (OR, 0.70; 95%CI, 0.67~0.74), chronic kidney disease (OR, 0.72; 95%CI, 0.55~0.95), initial HbA1c value (OR 0.87, 95%CI 0.79~0.95), and LAA (OR 0.70, 95%CI 0.55~0.88) had a nega-tive association with a good outcome. Acute stroke recurrences within 3 weeks after the onset were observed in 2.0%, 2.5%, 6.1%, and 9.4% in Group A-D patients respectively (p<0.0001). Stroke recurrences during 1 year were observed 7.0%, 10.7%, 11.6%, and 13.8% in Group A-D patients re-spectively (p<0.0001). A good outcome (mRS of 0-1) 1 year after the onset was observed in 77.0%, 66.4%, 67.9%, and 65.8% in Group A-D patients respectively (p<0.0001). With regard to the Ka-plan- Meier method, stroke recurrences were most frequent in Group D (p<0.0001, Log-rank test). Conclusions: In Japanese minor stroke, age, NIH stroke scale score, chronic kidney disease, HbA1c, and LAA were significant predictors for the long-term outcome. In patients with both AF and LAA, stroke recurrences were most frequent, especially in the acute phase, and a long-term good outcome was least frequent consequently.
Karger_ESC London_2013
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