Abstract WMP69: Recreational Drug Use And Ischemic Stroke: Demographics, Stroke Mechanism, And Outcomes

Abstract

Introduction: Various recreational drugs have been linked to cerebrovascular events, especially in young adults, however, few studies have examined relationships between substance abuse (SA) and acute ischemic stroke (AIS) in detail. The objective of this study was to determine prevalence and stroke mechanism in a cohort of AIS patients with SA and the impact of SA on outcomes and recovery. Methods: A retrospective case-control study comparing adults hospitalized with AIS with positive urine drug screen (UDS, excluding cannabis and its related products) from January 2015 to December 2019 compared with matched AIS controls from Greater Chicago area. Logistic regression was used to compare demographics, mechanism of stroke, discharge outcomes as measured by modified Rankin Scale (mRS), and disposition outcomes. Results: Out of 3229 AIS patients, 141 (6.5%) has positive UDS (SA group) and were compared to 282 controls. Illicit drugs used were cocaine (69%), opiates (21%), and the rest were amphetamines, phencyclidine, ecstasy, or multiple substances. Demographically, there were no significant differences in age [56.0±10.0 years vs 55.9±10.5], or sex [men 63.1% vs 60.3%]. Controls had higher rates of traditional stroke risk factors [diabetes (DM), p=0.0001 and hyperlipidemia (HLD), p=0.004], and a higher incidence of large artery atherosclerosis as suspected stroke mechanism than the SU group (p = 0.001). SA group at discharge had higher levels of disability [median mRS 2 vs 3 (p = 0.001)] and worse discharge disposition, i.e. subacute rehab/long term care facility/hospice/death vs home or acute rehabilitation (OR 0.49, p =0.009, CI 0.29-0.84), even after correcting for age, sex, HTN, DM, coronary artery disease, and HLD in a multiple logistic regression (OR 0.43, p= 0.004, CI 0.24-0.76). Conclusion: In our cohort, patients with AIS and SA were more likely to have a stroke mechanism of large artery atherosclerosis and poorer outcomes with higher levels of disability and worse discharge disposition.