Abstract WP122: Clinical Indicators To Identify Non-early Improvement After Stroke Treatment In The Extended Treatment Window Era

Abstract

Background: There are few clinical indicators beyond imaging to aid in the prediction of improvement after treatment for acute ischemic stroke. We aimed to identify patient characteristics that serve as predictors to identify patients who may be less likely to have a clinically significant improvement after treatment. Methods: We performed a retrospective chart review of ischemic stroke treatment cases (tPA, EVT or both) at Hartford Hospital between January 1st, 2020 to December 31st, 2021. Stroke was diagnosed with MRI imaging. Patients were divided into those who had early improvement and those who did not have early improvement. Early improvement was defined as a reduction in NIH of 50% or more at 24 hours post treatment. We excluded patients who did not receive a routine CT scan at 24-hours for surveillance of hemorrhage. We identified potential predictors by comparing two demographic (age, gender) and 19 patient health characteristics between groups. Any variables that were significantly different (P<.05) between groups were then examined as a predictor in a multivariate logistic regression analysis, while controlling for therapeutic intervention and time to treatment in the model. Results: A total of 363 patient records met inclusion criteria; 223 had early improvement and 140 did not. Patients were aged 71.74±15.65yr and 52.1% were female. There were eight potential predictors identified and included in the regression analysis. Higher blood pressure [odds ratio (OR)=0.991; 95% confidence interval (CI)=0.98, 1.00; P=.02], and statin use (OR=0.276; 95% CI=0.16, 0.47; P<.001) were associated with a decreased likelihood of early improvement. Conclusion: Our findings indicate that patients who are taking statins and/or have high blood pressure have a decreased likelihood of having an early improvement following stroke treatment. Clinicians should consider these factors when putting together treatment plans for ischemic stroke patients. The association between statin use as well as systolic blood pressure and improvement after stroke treatment should be further examined in a randomized controlled trial.