Abstract TMP96: Area Deprivation Index (ADI) And NIHSS Predicts The Infarct Growth Rate (IGR)

Abstract

Introduction: Socioeconomic status has been shown to affect the clinical outcome of cardiovascular disease and stroke. Early clinical severity and infarct growth rate (IGR) are highly variable across patients with anterior circulation large vessel occlusion (ACLVO) stroke but remain poorly understood. We aimed to measure the social determinants of early NIHSS and IGR in ACLVO stroke using the Area Deprivation Index (ADI), which incorporates housing, education, income, and employment status at the neighborhood level. Methods: Single-center retrospective study of all patients with acute intracranial ICA or proximal MCA occlusion and baseline CTP or MRI within 24 hours of stroke onset from 2014-2017. IGR (ischemic core volume / stroke onset to core imaging time, ml / hours) was calculated. Demographics, co-morbidities, admission NIHSS, ADI, and median income data were collected. Multivariable linear regression models tested the independent association between ADI and NIHSS (model 1) or IGR (model 2, including NIHSS). Results: A total of 165 patients were included in the analysis, with mean age 71 (SD, 15), 40 % male sex and median NIHSS 17(IQR, 12--21). In model 1, ADI (coefficient 0.07, 95% CI 0.025-0.13, P=0.004) and age (coefficient 0.11, 95% CI 0.4—0.19, P=0.003) were the only independent predictors of NIHSS. In model 2, ADI (coefficient 0.11, 95% CI 0.004-0.21, P=0.04) and NIHSS (coefficient 0.46, 95% CI 0.16-0.76, P=0.003) were the only independent predictors of IGR. Median income, sex, diabetes or hypertension status were not independently associated with NIHSS or IGR in these models. Conclusions: ADI is independently associated with worse stroke severity and faster infarct progression of ACLVO stroke. These findings have possibly important implications for public health care planning of stroke systems of care and enrollment in clinical trials of reperfusion therapies.