Abstract T MP80: Prior Beta Blocker Use is Associated with Favorable Outcome in Patients with Acute Insular Stroke

Abstract

BACKGROUND: Sympathetic nervous system activation during acute ischemic stroke (AIS) can lead to a number of undesirable changes such as hyperglycemia, left ventricular stunning, and immunosuppression and thereby could potentially result in worsening of clinical and tissue outcome. We hypothesized that prior beta blocker (BB) use could be beneficial in patients with AIS by opposing increased sympathetic activity. METHODS: This was a consecutive study of patients with AIS conducted as a part of an ongoing prospective NIH-funded study (Heart-Brain Interactions Study). The relationship between BB use within 24 hours prior to stroke onset and outcome measured by modified Rankin Score (mRS) at 3 months was tested using multiple logistic regression. Infarcts including the insula and/or the surrounding opercular cortex were classified “insular”. RESULTS: There were 402 BB-users and 612 BB non-users. BB-users were older and more often had vascular risk factors such as coronary artery disease, atrial fibrillation, and congestive heart failure. Univariate analyses revealed that prior BB use was associated with decreased probability of good outcome (OR 0.72, 95% CI 0.55 - 0.93 for mRS<3). A multivariable analysis adjusting for differences between BB-users and BB non-users showed that BB use was not a predictor of either good or bad outcome (OR 1.33, 95% CI 0.90 - 1.96). However, there was a significant interaction between BB use and insular infarction (p=0.04). A second multivariable model also including the interaction term showed that prior BB use was a significant predictor of favorable outcome in patients with infarcts including the insula (OR 2.21, 95% CI 1.03 - 4.75). CONCLUSIONS: These findings suggest that BB therapy may be beneficial in selected patients with AIS whose infarcts encompass the insula.