Abstract T MP22: Defining Mild Stroke: Outcomes Analysis of Treated and Untreated Mild Stroke Patients
Introduction: Mild deficit is a relative contraindication for the administration of IV rtPA in the setting of acute stroke. However, the definition of "mild" has not been well specified until recently. Prior studies have shown that patients with mild ischemic stroke have substantial disability rates at hospital discharge and at 90 days. We investigated whether the application of this new definition altered the rates of disability overall, and in association with treatment.
Methods: This analysis included all adult acute ischemic stroke patients from a prospective registry of consecutive patients (the UCSD SPOTRIAS database, 2003-2013) with 90 day mRS score available who were defined as “mild” using a recently proposed definition from the TREAT Task Force (NIHSS 0-5 and not clearly disabling based on pre-specified syndromes). Dichotomized 90-day mRS scores (0-1 vs. 2-6) were compared between treated and non-treated patients and the subgroup of non-treated patients whose only exclusion reason was "deficit too mild."
Results: Of 212 TREAT-defined mild stroke patients, 54 were rtPA-treated. Treated and non-treated patients had similar baseline characteristics except that the treated group had more smokers (79.6% vs. 58.9%; p=0.008), higher median NIHSS (3 vs. 2; p<0.0001), and different racial makeup (p=0.011). In both groups, 37% had mRS 2-6 at 90 days. Of 158 non-treated patients, 36 were reported by the clinician to be excluded from rtPA because the deficit was "too mild"; these patients had no other rtPA exclusion criteria. These 36 patients had similar baseline characteristics to the treated population except for lower baseline NIHSS, and 33% had mRS 2-6 at 90 days.
Conclusion: More than one-third of patients who fit the TREAT Task Force definition of "mild stroke" were not functionally independent (mRS 2-6) at 90 days, irrespective of treatment, raising the question of treatment efficacy for mild strokes. This study was likely underpowered to detect a significant treatment effect and is limited by its retrospective design. There remains equipoise regarding best acute treatment strategies for mild stroke patients. Randomized studies are necessary to determine rtPA treatment efficacy in mild stroke patients.
Author Disclosures: I. Spokoyny: None. R. Raman: Research Grant; Modest; NIH NS044148. K. Ernstrom: Research Grant; Modest; NIH NS044148. T.M. Hemmen: Research Grant; Modest; NIH NS044148, Genentech. Consultant/Advisory Board; Modest; Merck, Co, Boehringer Ingelheim. P. Khatri: Honoraria; Modest; Academic Grand Rounds (paid to Dept). Other; Modest; Taylor and Francis-Stroke Ctr Handbook book royalties (paid to Dept). Research Grant; Significant; NIH/NINDS (IMS III, NSTN NCC/RCC). Other Research Support; Significant; Significant; Genentech-PRISMS Trial PI (paid to Dept), Penumbra-THERAPY Trial PI (paid to Dept). B.C. Meyer: Research Grant; Modest; NIH NS044148. Speakers' Bureau; Modest; Genentech, Boehringer Ingelheim.
- © 2014 by American Heart Association, Inc.