Abstract W MP14: Early Infarct Growth Predicts Long-term Clinical Outcome in Ischemic Stroke
Background: Ischemic lesion is dynamically evolving during acute phase of stroke. However, it is still controversial whether early changes in ischemic lesion have a prognostic information in addition to clinical variables. We hypothesized that early infarct growth on diffusion-weighted imaging (DWI) might be independently associated with long-term outcome.
Methods: This was a prospective study of acute ischemic stroke patients who underwent DWI at baseline (within 24 hours) and at 5-day after stroke onset. Early infarct growth was defined as the difference between the final and the baseline infarct volume. Clinical outcomes were assessed using the modified Rankin Scale (mRS) at 3 months. Univariate and multivariate analyses were performed to assess the relationship between early infarct growth and clinical outcomes. The cut-off values of early infarct growth predicting long-term clinical outcomes were estimated using receiver operating characteristic analysis.
Results: Of total 409 patients included, 345 (84.4%) showed any early infarct growth (median, 0.63cm3, interquartile range, 0.11-6.33cm3). After adjusting age, diabetes, baseline National Institutes of Health Stroke Scale, and baseline infarct volume by multiple logistic analysis, infarct growth was an independent predictor of poor clinical outcomes (for mRS 2-6, odds ratio [OR], 1.03, 95% confidence interval [CI], 1.002-1.06, p=0.04; and for mRS 3-6, OR, 1.03, 95% CI, 1.01-1.05, p=0.01). The cut-off values of early infarct growth discriminating between good and poor outcomes were 0.99cm3 for mRS 0-1 vs. 2-6 (area under curve [AUC], 0.685, p<0.001) and 8.86cm3 for mRS 0-2 vs. 3-6 (AUC, 0.736, p<0.001).
Conclusions: Infarct growth within a week of symptom onset independently predicts 3-month clinical outcomes. This suggests that short-term changes in infarct volume may serve as a surrogate marker of long-term clinical outcomes after ischemic stroke.
Author Disclosures: S. Kim: None. D. Lee: None. S. Kwon: None. S. Kim: None. J. Kim: None. D. Kang: None.
- © 2014 by American Heart Association, Inc.