Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion
Vivek Yedavalli MD, MS , Manisha Koneru MS , Meisam Hoseinyazdi MD , Karen Copeland PhD , Risheng Xu MD, PhD , Licia Luna MD, PhD , Justin Caplan MD , Adam Dmytriw MD, MPH, MSc , Adrien Guenego MD, PhD , Jeremy Heit MD, PhD , Gregory Albers MD , Max Wintermark MD, MS, MBA , Fernando Gonzalez MD , Victor Urrutia MD , Judy Huang MD , Richard Leigh MD , Elisabeth Marsh MD , Rafael Llinas MD , Marlis Gonzalez Hernandez MD, PhD , Argye Hillis MD
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引用次数: 0
Abstract
Objective
To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning.
Design
In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant.
Setting
Hospitalized care.
Participants
In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores.
Interventions
None.
Main Outcome Measures
Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17.
Results
Patients with favorable AM-PAC were younger (61.3 vs 70.7, P<.001), had lower admission glucose (mean, 124 vs 136, P=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, P<.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, P<.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (P<.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86).
Conclusion
Excellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.