Abstract W P373: Symptom Severity of Recent Stroke and Risk of Recurrent Vascular Events

Abstract

Background: Symptom severity of an index stroke is a powerful prognosticator of short term outcomes, especially functional status and mortality. It is widely recognized that stroke patients with greater initial symptom severity tend to have more unfavorable prognoses. However, little is relatively known about the possible association of symptom severity and risk of recurrent vascular events after a recent index stroke, particularly over the longer term. On one hand, stroke patients with greater baseline symptom severity may be at higher risk for recurrent vascular events due to reactive depression or impaired mobility leading to overall poorer regimen adherence; while on the other hand stroke patients that recover with minimal deficit or no deficit may be more vulnerable to a future events due to underlying unstable pathophysiology (i.e. ongoing thrombosis-thrombolysis). 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 stroke severity (as measured by National Institutes of Health Stroke Scale [NIHSS] score) with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcome) were analyzed. NIHSS score was analyzed as a dichotomous (<4 vs. ≥4) and a continuous variable. Results: Among trial participants, 550 (15%) had NIHSS scores ≥4 (overall scores ranged from 0 to 18, median score was 1 [25 th to 75 th percentile 0 to 2]). NIHSS was measured median 35 days after the qualifying stroke. Scores ≥4 were independently linked to higher risk of recurrent stroke (HR 1.43, 95% CI: 1.06-1.92) and risk of stroke/CHD/vascular death (1.32; 1.07–1.64). Analysis of NIHSS score as a continuous variable also showed a higher risk of events with increasing symptom severity (recurrent stroke: 1.07; 1.01–1.13) and stroke/CHD/vascular death: 1.05; 1.01-1.09) Conclusions: Greater symptom severity of a recent stroke is associated with higher risk of recurrent vascular events including stroke. Future studies are needed to confirm this relationship and to clarify its underlying mechanisms.