Abstract W P14: Significant Correlation between Neurological and Functional Recoveries in the Natural History of Acute Ischemic Stroke from Large Vessel Occlusion
Purpose: There have been conflicting reports on the correlation between neurological and functional recoveries in acute ischemic stroke. NIHSS and mRS scores not always correlated in patients after treatment. Since the inconsistencies could be related to the variable effectiveness of treatments, the aim of this study was to test their correlation in patients with large vessel proximal occlusion who are eligible but not treated with endovascular therapy. In addition, we analyzed the data based on trichotomized ASPECTS scores to minimize the confounding influence of the infarct core.
Methods: The FIRST Trial is a prospective natural history study of a stroke cohort eligible for but untreated by endovascular therapy and ineligible or refractory to IV rtPA. NIHSS and mRS scores were measured in 93 patients at admission, 24 hour and 7 days after hospital presentation and were analyzed by logistic regression against different core infarct volume as indexed by ASPECTS scores of 8-10, 5-7, and 0-4.
Results: Median admission NIHSS score was 18 (IQR 14-23, N=93). The mean and mean increase at 24 h NIHSS both showed correlations with trichotomized ASPECTS, p=0.0064 and 0.0202, respectively. NIHSS at 24 h and 7 days displayed a strong relationship with 90 day mRS 0-2 (p=0.0002, N=67; p=0.0003, N=66). NIHSS had a strong correlation to 90 day mRS scores (continuous), with high 7 day scores correlated with high mRS scores and 7 day NIHSS change negatively correlated to 90 day mRS scores (Spearman correlations, all p<0.0001). Significant correlations were seen between 24 h and 7 day NIHSS and 90 day mRS by trichotomized ASPECTS (both p=0.04275). In addition, controlling for trichotomous ASPECTS groups, 7 Day NIHSS score was the best predictor of mRS 90d 0-2 (OR= 0.717, p= 0.0018).
Conclusion: These data indicate that there is a strong correlation between neurological and functional recoveries in the natural history of acute ischemic when the confounding influences of treatment and the infarct core are taken into account.
Author Disclosures: V. Janardhan: Other Research Support; Modest; Penumbra - Clinical Trial; Stryker - Target Registry; Cordis - SAPPHIRE WW Registry. Ownership Interest; Significant; Insera Therapeutics Inc. Consultant/Advisory Board; Modest; Penumbra Inc - Data Safety Board Member of Penumbra Pivotal Trial. Consultant/Advisory Board; Significant; Board Member - Insera Therapeutics Inc. A.J. Yoo: Other Research Support; Modest; Dutch Heart Foundation. Research Grant; Significant; Penumbra Inc. D.F. Frei: Ownership Interest; Significant; Penumbra, Inc. L. Ammar: Employment; Significant; Penumbra, Inc. S.S. Kuo: Employment; Significant; Penumbra, Inc. D. Ueda: Employment; Significant; Penumbra, Inc. N. Nguyen: Employment; Significant; Penumbra, Inc. A. Bose: Employment; Significant; Penumbra, Inc.. Ownership Interest; Significant; Penumbra, Inc. S. Sit: Employment; Significant; Penumbra, Inc.. Ownership Interest; Significant; Penumbra, Inc..
- © 2015 by American Heart Association, Inc.