London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 317 72 Stroke prognosis CLINICAL AND RADIOLOGICAL FACTORS ASSOCIATED WITH LATE FUNCTIONAL RECOVERY IN STROKE DUE TO ANTERIOR CIRCULACION LARGE ARTERY OC-CLUSION M. Hernandez-Perez1, N. Perez de la Ossa2, E. Lopez-Cancio3, M. Almendrote4, M. Jimenez5, L. Dorado6, M. Millan7, M. Gomis8, A. Davalos9 Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN1, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN2, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN3, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN4, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN5, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN6, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN7, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN8, Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN9 Background: Several studies have described prognostic factors related with clinical outcome at 3 months after stroke. However, little is known about predictors of late-term improvement. Our aim was to study the clinical and radiological variables associated with functional improvement between 3 and 12 months after stroke. Methods: We included consecutive acute ischemic stroke patients < 80-year old admitted within 12h of an anterior circulation large artery occlusion (ACLAO) during a 30 months period. Clinical and radiological data were obtained at admission, discharge, 3 and 12 months. The primary outcome was the change in late-term functional outcome defined as the differ-ence between the modified Rankin Scale (mRS) scores at 3 and 12 months. Results: One hundred patients were recruited (age 66±12 y, 63% male, median NIHSS 17). 44% of patients received i.v. tPA alone, 36% endovascular treatment (primary or rescue treatment) and 20% were not treated with reperfusion therapies. At 90 days, 25 patients reached mRS 0 and 3 had died. Out of 73 patients with some degree of disability after 3 months, 33.3% showed late-term improvement. No patient with mRS>3 at three months reached functional independence (mRS ≤2) at 12 months. Reperfusion ther-apies (p 0.01), successful recanalization (p 0.01), NIHSS<8 at 24h (p 0.01), younger age (p <0.01), smaller lesion at 24h (p <0.01) and subcortical lesion (p 0.05) were factors associated with late-term improvement. Age (β -0.34) and NIHSS<8 at 24h (β 0.25) were independently associated with im-provement in the Rankin score between 3 and 12 months in a lineal regression model. Conclusion: Functional improvement between 3 and 12 months is identified in one third of acute stroke patients with ACLAO and persistent symptoms at three months. Age and moderate stroke severity at 24h are major determinants of late-term change in functional outcome.rm change in functional outcome. 73 Stroke prognosis Subclinical hyperthyroidism is a risk factor for poor functional outcome after ischemic stroke F.A. Wollenweber1, V.D. Zietemann2, C. Opherk3, M. Dichgans4 Institute for Stroke and Dementia Research, Ludwig-Maximilians-University, Munichg, GER-MANY1, Institute for Stroke and Dementia Research, Ludwig-Maximilians-University, Munich, GERMANY2, Institute for Stroke and Dementia Research, Ludwig-Maximilians-University, Mu-nich, 3, Institute for Stroke and Dementia Research, Ludwig-Maximilians-University, Munich, GER-MANY4 Background – Subclinical hyperthyroidism is associated with adverse cardiovascular events in-cluding stroke and atrial fibrillation (AF). However, its impact on functional outcome after stroke remains unexplored. Methods – 165 consecutively recruited patients admitted for ischemic stroke were included in this observational prospective study. Blood samples were taken in the morning within 3 days after symptom onset and patients were divided into the following 3 groups: subclini-cal hyperthyroidism (0.1<TSH≤0.44μU/ml), subclinical hypothyroidism (2.5≤TSH<20μU/ml), and euthyroid state (0.44<TSH<2.5μU/ml). Patients with overt thyroid dysfunction were excluded. Fol-low- up took place 3 month after stroke. Primary outcome was functional disability (modified Rankin Scale, mRS), secondary outcome level of dependency (Barthel Index, BI). Ordinal logistic regres-sion analysis was used to adjust for possible confounders. Variables previously reported to be affect-ed by thyroid function such as AF, total cholesterol or body mass index (BMI), were included in an additional model. Results – 19 patients (11.5%) had subclinical hyperthyroidism and 23 (13.9%) had subclinical hypothyroidism. Patients with subclinical hyperthyroidism had a substantially increased risk of functional disability compared to subjects with euthyroid state (OR=2.63, 95% CI: 1.02-6.82; adjusted for age, sex, smoking status, and time of blood sampling). The association remained signif-icant when including the additional variables (OR=3.95; 95% CI: 1.25-12.47) and was confirmed by the secondary outcome (BI: OR= 9.12; 95%CI: 2.08-39.89). Conclusion – Subclinical hyperthyroid-ism is a risk factor for poor outcome 3 months after ischemic stroke. Table 1. TSH-level and functional outcome 3 months after ischemic stroke Model 1 OR 95%CI (p-value) Model 2 OR 95%CI (p-value) Modified Rankin Scale hyperthyroidism vs. euthy-roid state hypothyroidism vs. euthy-roid state 2.63 1.02-6.82 (p=0.046) 0.78 0.27-2.22 (p=0.64) 3.95 1.25-12.47 (p=0.019) 0.75 0.22-2.55 (p=0.64) Barthel Index hyperthyroidism vs. euthy-roid state hypothyroidism vs. euthy-roid state 3.63 1.27-10.35 (p=0.016) 0.90 0.25-3.18 (p=0.87) 9.12 2.08-39.89 (p=0.003) 0.52 0.09-2.80 (p=0.44) Ordinal logistic regression with mRS categorised into 3: 0-1 (n=109), 2-3 (n=41), 4-6 (n=15). Model 1: adjusted for age, sex, smoking status, and time between symptom onset and blood sam-pling. Model 2: additionally adjusted for NIHSS, TIA, serum CRP, AF, BMI, and total cholesterol.
Karger_ESC London_2013
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