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London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 691 652 Acute stroke: clinical patterns and practice Comparing disability and mortality following ischemic stroke in the UK and US T.M. Hemmen1, J.M. Lee2, S Middleton3, M. Randall4, N.S. Rost5, G.J.E. Rinkel6, A. Bottle7 University of California, San Diego, La Jolla, USA1, Washington University in St. Louis, St. Lou-is, USA2, Dr Foster Intelligence, London, UNITED KINGDOM3, University of Sheffield, Sheffield, UNITED KINGDOM4, Massachusetts General Hospital, Boston, USA5, UMC Utrecht, Utrecht, 6, Dr Foster Unit at Imperial College London, London, UNITED KINGDOM7 Background: Stroke is a leading cause of case fatality and morbidity worldwide. Evaluating the quality of systems of care across institutions and countries is challenging as most case-mix severity adjustments do not account for initial stroke severity and are modeled after in-hospital morbidity. We aimed to compare 30 and 90 day outcomes using data from centers in the United Kingdom (UK) and the United States (US), adjusting for NIHSS. Methods: We included all patients who were admitted with the acute ischemic stroke to the 5 US and 5 UK hospitals within the Dr Foster Stroke GOAL network from March to May 2012. Patients received NIHSS scoring within 24 hours of admission or before IV tPA and had a 30-day and 90-day mRS in person or via telephone performed. We captured age, sex and compared 4 different outcome models between countries: i) death within 30 days (mRs 6), ii) death within 90 days, iii) mRs 0-1 at 30 days, iv) and mRS 0-1 at 90 days. We adjusted for age, sex, country and NIHSS on admission. Results: A total of 583 hospital admissions were included, 228 from UK, 355 from US hospitals. UK patients were older (mean age difference 6.4 years (95%CI 4.1 to 8.7, p<0.0001) and had a higher mean NI-HSS (Difference 1.0 higher than US (95%CI -0.2 to +2.2, p=0.12). Outcomes were i) UK 9.2% versus US 14.1%; ii) 14.7% versus 18.6%; iii) 37.7% versus 35.2%, iv) 42.9% versus 41.2% (all NS). While crude outcomes did not differ between the UK and US, After adjustment for baseline NI-HSS, 30-day (i) and 90-day (ii) mortality were lower in the UK OR=0.35 (95% CI 0.18-0.67) for i, OR=0.62 (CI 0.41-0.93) for ii. frequency of good clinical outcome in the UK was higher at 30 (iii), but not at 90 days (iv). Conclusion: Ischemic stroke patients in the UK had better clincial outcomes at 30-days and reduced mortality at 30 and 90 days, while 90-day outcomes were similar between groups. Further studies are needed to show if 30-day outcomes are reliable final outcome measures. We plan to expand this anaylis to in-clude other participating countries within the Stroke GOAL group. 653 Acute stroke: clinical patterns and practice Neurological deficits, Risk Factors and plain CT predict presence and site of Acute Arterial Occlusion in Ischemic Stroke P. Vanacker1, M. Faouzi2, A. Eskandari3, P. Michel4 Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZERLAND1, Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, SWITZERLAND2, Centre Hospitalier Universitaire Vaudois, Lausanne, SWITZERLAND3, Centre Hospitalier Universitaire Vaudois, Lau-sanne, SWITZERLAND4 Background: Large-vessel occlusive disease frequently occurs within the setting of acute ischemic stroke. The limited information on predictors of presence, site and extent of arterial occlusions in the ischemic territory has resulted in suboptimal selection of candidates for endovascular treatment. Methods: Subjects enrolled in the ASTRAL registry with acute ischemic stroke and CTA imaging (<12h) were selected and categorized according to occlusion site (intracranial IC, extracranial EC, proximal IC, peripheral IC and tandem). Easily accessible demographic, clinical, physiologi-cal and radiological data were used in the multivariate analysis. Results: Of the 1645 patients enrolled, significant proportion (46%) had vessel occlusions in isch-emic territory. Clinical predictors of any vessel occlusion were in-hospital stroke (OR2.1, 95%CI 1.4-3.1), higher NIH Stroke Scale score (1.1, 1.1-1.2), presence of visual field defects (1.9, 1.3-2.6), dysarthria (1.4, 1.0-4.9), hemineglect (2.0, 1.4-2.8), known history of atrial fibrillation (1.7, 1.2-2.3) or absence of cancer (0.4, 0.2-0.7). Shorter time to imaging (0.9, 0.9-1.0), presence of early isch-emic changes (2.3, 1.7-3.2) and absence of silent lesions (0.7, 0.5-1.0) were also associated. Look-ing at different occlusion sites, only acute stroke severity (NIHSS) and early ischemic changes on CT were detected as independent predictors in all the subgroups. IC occlusions showed a specific correlation with the presence of atrial fibrillation (2.1, 1.5-2.9). EC occlusions occurred more fre-quently in males (0.52, 0.4-0.7), with history of hypercholesterolemia (1.9, 1.3-2.8) or peripheral vascular disease (2.4, 1.3-4.4). Conclusion: Neurological deficits, risk factors and CT findings identify patients at risk of symptom-atic vessel occlusion in the early phase of stroke. Different occlusion sites are associated with specif-ic patterns of predictors. This information may help to select patients for recanalisation treatments.


Karger_ESC London_2013
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