Abstract WP400: Greater Stroke Severity Predominates Over All Other Factors For The Worse Outcome Of Cardioembolic Stroke

Abstract

Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contribution has not been well explored. Methods: Using a stroke outcome registry, we compared the outcomes of CE and non-CE strokes. The relative contribution of prognostic factors was assessed with multivariable models and model fitness improvement using -2 log-likelihood and Nagelkerke’s R 2 . Results: A total of 1233 patients were included in this analysis. As compared to non-CE strokes, CE strokes had less mRS 0-2 outcomes (47.2% vs 68.5%, p<0.001), less mRS 0-1 outcomes (33.7% vs 53.5%, p<0.001), more mRS 5-6 outcomes (32.1% vs 10.9%, p<0.001), and higher mortality (19.2% vs 5.2%, p<0.001). When adjusting either baseline demographics or poststroke complications, the outcome differences remained significant. However, adjusting initial NIHSS score alone abolished the differences in mRS 0-2 outcome (Figure) and mRS 0-1 and mRS 5-6 outcomes. For mRS 0-2 outcome, the differences in -2 log-likelihood and Nagelkerke’s R 2 between univariable model and multivariable model were greater with adjusting NIHSS alone (-2 log-likelihood difference, 418; Nagelkerke’s R 2 difference, 38.7%) than with adjusting baseline demographics (184; 17.7%) or poststroke complication (279; 27.3%). Further adjustment of baseline demographics and poststroke complication to the initial NIHSS score adjustment resulted in a small shift of odds ratio. The decrement of -2 log-likelihood and the Nagelkerke’s R 2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the model adjusting baseline demographics, poststroke complication, and initial NIHSS score. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke.