Abstract W P142: Can Peripheral Arterial Disease Markers Predict the Outcome of Non-cardioembolic Stroke Patients?

Abstract

Introduction: In acute stroke patients, ankle-brachial index (ABI)>0.9 is a clear predictor of increased stroke recurrence risk. However, it has not been defined whether clinical markers of peripheral arterial disease could predict the outcome of non-cardioembolic stroke. Hypothesis: We assessed the hypothesis that clinical markers (e.g. ABI and pulse wave velocity [PWV]) of peripheral arterial disease could predict the outcome of non-cardioembolic stroke. Methods: In our Brain Attack Center, 5432 acute ischemic stroke patients were admitted in January 2007 to December 2012. Among them, 686 lacunar or atherothrombotic stroke (TOAST criteria) patients (248 female and 438 male, median age 70.0 (range 35 to 96)) who admitted within 7 days after their onset and evaluated ABI and PWV during hospitalization were retrospectively examined in this study. Baseline characteristics and NIHSS scores at admission were noted, and modified Rankin scale (mRS) scores 3 months after stroke were evaluated. The patients were categorized into normal (≥0.9) and decreased (<0.9) ABI groups, and into good-outcome (mRS score, 0,1) and poor-outcome (mRS score, 2_6) groups. Results: ABI was decreased in 28 (5.7%) of 496 good-outcome patients and 22 (11.6%) of 190 poor-outcome patients (p=0.008). PWV was increased in the patients with poor-outcome (2116.6±477.5 cm/s) compared with the patients with good-outcome (1934.9±415.6 cm/s, p<0.001). The patients were categorized into low- or high-PWV with a cutoff (2163 cm/s) determined from a receiver operating characteristics curve against the patients’ outcome. The poor-outcome of patients were predicted with high-age (≥75years), NIHSS score at admission, low-ABI, and high-PWV, independently (overall Χ 2 =86.7, R 2 =0.107, n=686, p<0.001; low-ABI: odds ratio 2.13 [95% confidence interval 1.12 to 4.01], p=0.022; high-PWV: odds ratio 2.36 [95% confidence interval 1.61 to 3.45]). Conclusion: Our results showed that the poor-outcome of patients were predicted with ABI and PWV even after controlling age and NIHSS score. It is important to evaluate clinical markers (ABI and PWV) of peripheral arterial disease in the non-cardioembolic stroke patients.