Abstract T P63: Stroke Averted by Tissue Plasminogen Activator Can be Predicted by Baseline Factors but is Associated With Undetermined Etiology
Background: Limited investigation of the distinction between averted and completed stroke has been performed. We sought to determine baseline characteristics predictive of averted stroke and compare the evaluation and TOAST classification in patients with averted strokes to those of patients with completed stroke.
Methods: Patients admitted to our stroke center (07/08-06/13) and treated with IV tPA were retrospectively assessed. Patients were excluded if they were transferred from an outside hospital or if an MRI was not completed. Averted stroke was defined as complete reversal of neurological deficits within 24hrs of onset and DWI-negative MRI. Patients with DWI-negative MRI and persistent deficits or alternate identified etiology were not given a stroke diagnosis. Completed stroke was defined as DWI positive MRI. Univariate and multivariate analyses were performed for averted versus completed stroke based on baseline characteristics, work-up, and TOAST classification.
Results: Of the 325 patients who met inclusion criteria, 106 (32.6%) experienced an averted stroke. Compared to patients with completed stroke, averted stroke patients were younger (median 61 vs 66, p<0.0001), were more likely to have prior history of stroke (35% vs 26%, p=0.0496), had lower median presenting systolic blood pressure (150 vs 157, p=0.0050), and lower median baseline NIHSS scores (6 vs 11, p<0.001) (Table). Averted stroke patients were less likely to have TEE performed (23% vs 32%, p=0.0235) even after adjustment for age, race, gender, and baseline NIHSS score (OR 0.49, CI 0.29-0.85, p=0.011). By TOAST classification, patients with averted strokes were more likely to have cryptogenic strokes (58% vs 22%, p<0.0001; adjusted OR 5.09, CI 2.98-8.70, p<0.001).
Conclusion: Averted stroke patients were more likely to be younger, have milder strokes and have cryptogenic etiology with less extensive work-ups. Further studies are warranted to explain these baseline differences.
Author Disclosures: D.J. Monlezun: None. A.J. George: None. M. Schwickrath: None. R. El Khoury: None. S. Martin Schild: None.
- © 2014 by American Heart Association, Inc.