Abstract T P166: Is Functional Disability after an Index Stroke a Risk Factor for Recurrent Vascular Events?

Abstract

Background: The modified Rankin Scale (mRS) is widely used as an index for measuring degree of functional disability following a recent stroke. However, greater degree of disability after stroke may unfavorably influence adherence to recommended medical and lifestyle practices shown to lower recurrent vascular event risk. We are unaware of published studies that have examined the possible association of post-stroke disability with occurrence of future vascular events. Methods: We reviewed the dataset of a multicenter trial involving 3680 recent non-cardioembolic stroke patients aged ≥35 years and followed for 2 years. Independent associations of post-stroke disability (as measured by modified Rankin Scale [mRS] score) with recurrent stroke (primary outcome), stroke, coronary heart disease (CHD), or vascular death as major vascular events (secondary outcome), and all-cause death (tertiary outcome) were analyzed. mRS score was analyzed as a dichotomous (≥2 vs. ≤1) and a dose dependent manner. Results: Among study participants, 1336 (36.3%) had a baseline mRS ≥2 (overall scores ranged from 0 to 3). Baseline mRS was measured at a median 35 days after the index stroke. Compared to mRS ≤1, mRS ≥2 was associated with higher risk of recurrent stroke (HR 1.26, 95% CI: 0.99-1.60), major vascular events (HR 1.17; 95% CI: 0.98–1.38), and all-cause death (HR 1.62; 95% CI: 1.21–2.16). Compared with mRS 0, there was progressively higher risk for stroke: mRS 1 (HR 1.40; 95% CI, 0.97-2.01), mRS 2 (HR 1.45; 95% CI, 0.98-2.14), mRS 3 (HR 1.99; 95% CI, 1.30-3.05). Compared with mRS 0, there was progressively higher risk for major vascular events: mRS 1 (HR 1.26; 95% CI, 0.99-1.61), mRS 2 (HR 1.30; 95% CI, 1.00-1.69), mRS 3 (HR 1.55 (95% CI, 1.15-2.09). Compared with mRS 0, there was progressively higher risk for all-cause death: mRS 1 (HR 1.50; 95% CI, 0.94-2.39), mRS 2 (HR 2.06; 95% CI, 1.27-3.35), mRS 3 (HR 2.41; 95% CI, 1.42-4.09). Conclusions: Greater functional disability after a recent stroke is linked to a higher risk of recurrent vascular events including stroke and all-cause death. Future studies with a wider range of mRS are needed to confirm this relationship and to clarify its underlying mechanisms.