Abstract WP352: Factors Affecting Short and Long-Term Outcome of Patients Diagnosed as Stroke Mimic at Index Event

Abstract

Background: Stroke mimics (SM) is a stroke-like clinical picture due to a disease other than cerebrovascular diseases. The causes of SM are diverse. Distinguishing SM from stroke is important to avoid unnecessary acute treatment and secondary prevention. PURPOSE: We hypothesized to evaluate short and long-term outcomes in terms of major adverse cardiovascular events (MACE) in patients who presented with SM. Methods: We evaluated a prospective cohort of Qatari patients with confirmed diagnosis of SM who presented to our hospital as suspected acute stroke between January 2014 and February 2019. We investigated the associated risk factors, short- and long-term risk of MACE in these patients. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval. Results: A total of 481 Qatari patients (mean age 57.5 ±18.0; 56.3% male) with diagnosis of SM were identified, of whom 126 (26.2%) patients were found to have MACE during follow up (36.7 months (95% CI 35.5-37.8). Patients who develop MACE were older (62.4 ±17.5 vs 55.7 ±17.9, p<0.001). Hypertension, diabetes and prior stroke and coronary artery disease was significantly more common in patients with MACE. High NIHSS on admission (2.5 ±4.1 vs 1.2 ±3.0, p<0.001), high glucose (7.5 ±2.2 vs 6.8 ±2.0, p= 0.005), lower HDL (1.0 ±0.3 vs 1.2 ±0.3, p<0.001) and extended length of stay at index event (3.9 ±5.6 vs 2.4 ±2.1, p<0.001) was higher in MACE. Patients with MACE had significantly worse outcome at discharge (46.0 vs 23.7%, p<0.001) and at 90-days (38.1 vs 0.4%, p<0.001). Once corrected, the long-term MACE-free survival function did not show any statistical difference between two groups Conclusions: Stroke mimics if associated with cardiovascular risk factors carry a poorer short and long-term prognosis after the first presentation. More aggressive reduction of cardiovascular risk may help in preventing such major cardiovascular events.