bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P61: Pulsatility Index Outperforms Conventional Imaging Markers in the Association With Cognition in Community Subjects
Authors: Lam Maggie L , Mok Vincent C , Lam Bonnie Y
Published: March 2021

Increase in pulsatility index (PI), measured by the transcranial Doppler (TCD), correlates with cognitive impairment and is associated with progression of non-demented patients into Alzheimer’s disease (AD) with dementia, suggesting that increase in small vessel resistance is a critical marker of cognitive decline. No study compared PI and MRI markers for small vessel disease or AD that have been shown to be associated with worse cognitive functions. The objectives of this study include: (i) compare PI against conventional MRI markers in its association with cognition, and (ii) investigate the association of PI and cognition in the presence of vascular risk factors.

We measured clinical data and PI in the middle cerebral artery in 331 stroke- and dementia-free community subjects. General cognition was assessed using Hong Kong-Montreal Cognitive Assessment. Conventional imaging markers (including lacunes, white matter hyperintensities (WMH), brain parenchymal fraction (BPF), cerebral microbleeds, Alzheimer’s Disease Resemblance Atrophy Index (ADRAI)) were assessed by MRI. Linear regression models were used to compare the sensitivity of PI against conventional MRI markers (including WMH, BPF, ADRAI, lacune and cerebral microbleeds count), with age and years of education entered as covariates.

PI was negatively associated with cognition (standardised b=-0.122, p=0.01). PI outperformed (standardised b=-0.118, p=0.012) other imaging markers and contributes to 1.1% change in the variance. PI was associated with higher systolic blood pressure (standardised b=0.122, p=0.028), and level of triglyceride (standardised b = 0.126, p = 0.021).

To conclude, PI is associated with cognition, higher levels of blood pressure and triglycerides, suggesting a vascular component in cognitive decline. PI outperforms conventional MRI markers in the association with cognition in community subjects without dementia. As TCD is non-invasive, portable with a lower cost than MRI, PI may serve as a simple marker in monitoring cerebral small vessel resistance and cognition in older people.
Abstract P614: Effect Sizes of Vascular Risk Factors for Stroke Occurrence by Age Among West Africans
Authors: Owolabi Mayowa , SARFO FRED S , Akpa Onoja , Akinyemi Joshua , Akpalu Albert , Wahab Kolawole , Obiako Reginald , Komolafe Morenikeji , Owolabi Lukman , Osaigbovo Godwin , Akinyemi Rufus O , Ovbiagele Bruce
Published: March 2021

Background:
Age is a non-modifiable risk factor for stroke occurrence due its influence on vascular risk factor acquisition. In sub-Saharan Africa, the effect sizes of vascular risk factors for stroke occurrence by age is unknown.

Objective:
To quantify the magnitude and direction of the effect sizes of key modifiable risk factors of stroke according to three age groups: <50years(young), 50-65 years(middle age) and >65 years(elderly) in West Africa.

Methods:
The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular, lifestyle, stroke severity and outcomes were performed. We used conditional logistic regression to estimate adjusted odds ratios (aOR) of vascular risk factors of stroke.

Results:
Among 3,553 stroke cases, 813(22.9%) were young, 1441(40.6%) were middle-aged and 1299(36.6%) were elderly. Five modifiable risk factors were consistently associated with stroke occurrence regardless of age namely hypertension, dyslipidemia, diabetes mellitus, regular meat consumption and non-consumption of green vegetables. Among the 5 co-shared risk factors, the effect size, aOR(95%CI) of dyslipidemia, 4.13(2.64-6.46), was highest among the young age group, hypertension, 28.93(15.10-55.44) and non-consumption of vegetables 2.34(1.70-3.23) was highest among the middle-age group while diabetes, aOR of 3.50(2.48-4.95) and meat consumption, 2.40(1.76-3.26) were highest among the elderly age group. Additionally, among the young age group cigarette smoking and cardiac disease were associated with stroke. Furthermore, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group.

Conclusions:
Age has a profound influence on the profile, magnitude and direction of effect sizes of vascular risk factors for stroke occurrence among West Africans. Population-level prevention of stroke must target both co-shared dominant risk factors as well as factors that are unique to specific age bands in Africa.
Abstract P617: Ischemic Strokes in Patients With Atrial Fibrillation: The Neuro-AFib Study
Authors: Gurol Edip M , Das Alvin S , Daoud Nader , Wohlfahrt Alyssa , Gokcal Elif , Yaghi Shadi , Smith Eric E ,   The Neuro-AFib Study Group
Published: March 2021

Background:
An estimated 150,000 atrial fibrillation (AF) patients suffer an ischemic stroke (IS) annually in the US. Understanding the frequency/causes of underuse and failures of current FDA-approved preventive methods in patients with known AF may reduce stroke risk and related death/disability.

Methods:
The Neuro-AFib study is a multicenter effort geared toward elucidating the causes and consequences of IS and hemorrhagic stroke (HS) in a contemporary AF cohort. The retrospective phase of the study is underway, aiming to obtain detailed clinical, laboratory and multimodal neuro- and cardiac imaging data from ~9,000 AF patients admitted to 30 US academic stroke centers with an IS or HS between 1/2018-12/2019. Clinical data of IS admissions from 12 sites will be discussed. Disability is defined as a modified Rankin Score (mRS) 3-5, outcomes are from the time of hospital discharge.

Results:
A total of 3944 AF patients presented with an IS, mean age was 76.8
+
12, and 50.2% were female. AF was diagnosed prior to IS in 78% of patients. Data on prestroke antithrombotic usage, embolic risk scores, clinical stroke severity and outcomes are presented in the FIGURE.

Conclusions:
Preliminary results from the Neuro-AFib study show high rates of underuse of approved stroke prevention measures (54%) and anticoagulant failures (46%) that result into IS even in known AF patients. Relatively high rates of pre-stroke AF detection failures were also noted (22%). Death/disability rates were high in all of these AF-related IS patients (
>
69%). Detailed data collection focused on imaging and lab markers of stroke risk from this contemporary cohort will be ready to be presented during ISC 2021.
Abstract P624: High Detection of Atrial Fibrillation by 90 Days Textil Holter Monitoring in Patients With Cryptogenic Stroke
Authors: Pagola Jorge , Juega Jesus , Francisco Jaume , Rodriguez Maite , Cabezas Juan Antonio , De Lera Mercedes , De Torres Reyes , Dorado Laura , Muchada Marian , Boned Sandra , Requena Manuel , Garcia Tornel Alvaro , Rodriguez Villatoro Noelia , Rodriguez-luna David , deck matias , Olive Marta , Rubiera Marta , Ribo Marc , Moniche Francisco , Arenillas Juan F , Montaner Joan R , Alvarez Sabin Jose , MOLINA Carlos A
Published: March 2021

Introduction:
External recorders allow for low-cost, non-invasive 1 to 4 weeks monitoring. However, the first 3 months of monitoring duration are the most effective to detect atrial fibrillation (AF). We show the results of the Thunder registry of patients monitored to detect AF during 90 days from the stroke.

Methods:
A prospective observational study was conducted with consecutive inclusion of patients with cryptogenic stroke after work up (neuroimaging, echocardiography and 24-hour cardiac monitoring) in 5 Comprenhensive Stroke Centers. Patients were continuously monitored for 90 days with a wearable Holter (Nuubo®) after the first 24 hours of the stroke onset. We analyzed the percentage of AF detection in each period (percentage of AF among those monitored), the quality of the monitoring (monitoring time), the percentage of AF by intention to monitor (detection of AF among patient included). Demographic, clinical and echocardiographic predictors of AF detection beyond one week of cardiac monitoring were assessed.

Results:
A total of 254 patients were included. The cumulative incidence of AF detection at 90 days was 34.84%. The monitoring time was similar among the 3 months (30 days: 544.9 hours Vs 60 days: 505.9 hours Vs 90 days: 591.25 hours) (p=0.512). The number of patients who abandoned monitoring was 7% (18/254). The cumulative percentage of intention to detect AF was 30.88% (Figure). Patients who completed monitoring beyond 30 days had higher score on the NIHSS basal scale (NIHSS 9 IQR 2-17) VS (NIHSS 3 IQR 1-9) (p=0.024). Patients with left atrial volume greater than 28.5ml/m2 had higher risk of cumulative incidence of AF according to the Kaplan Meyer curve beyond the first week of monitoring OR 2.72 (Log-rank (Mantel-Cox test) (p<0.001).

Conclusions:
In conclusion, intensive 90-day- Holter monitoring with textile Holter was feasible and detected high percentage of AF. Enlarged left atrial volume predicted AF beyond the first week of monitoring.
Abstract P639: Cerebrovascular and Pathological Findings in Police Chokehold Fatalities
Authors: Richardson Brian C , Rengifo Johanna , Stanton Michael , Nevarez Neftali , Román Cristina , Ranucci Alicia , Harley Aikisha , Mason Sara , Judd Tedd
Published: March 2021

Introduction:
A number of recent well publicized deaths from police chokeholds have focused attention on the use and safety of chokeholds by law enforcement officers (LEO). LEO chokeholds are depicted as a safe non-lethal restraint technique. Use of chokeholds by LEO is purported to be in the middle range of force options when compared to other tools of force available. LEO chokeholds are often likened to judo chokeholds which have a long history of safety and have not directly contributed to the death of a judoka since the sport of Judo was founded in Japan in 1882. Some have posited that chokeholds employed by LEO are especially likely to be safe in young adults, as they are less likely to have underlying cardiovascular diseases. Chokeholds applied by LEO can unfortunately be associated with severe medical and neurological sequelae, including death.

Methods:
We reviewed autopsy data of 29 deaths associated with LEO chokeholds.

Results:
Subjects ranged in age from 19 to 58. Reported chokehold duration ranged from 4 seconds to 3 minutes in length. In ten cases, chokeholds were applied multiple times to a single subject. In one case chokeholds were applied five times to a single subject. At autopsy, two subjects were found to have carotid artery intimal tears. Two subjects had epidural hemorrhages. One subject sustained a subdural hemorrhage. One subject was found to have had a subarachnoid hemorrhage. Five subjects had pathology typical of global cerebral anoxia. One subject sustained multiple cervical spine fractures with crush injury to the spinal cord as well as spinal epidural hemorrhage. Two subjects had evidence of hemorrhage involving the cervical anterior longitudinal ligament. Atherosclerotic heart disease was found in five subjects. Two subjects had severe occlusive coronary artery disease. Four of these subjects were between the ages of 28 and 35. Myocardial fibrosis was found in five subjects. Cardiomegaly was found at autopsy in six subjects.

Conclusions:
LEO chokeholds are not widely considered to constitute deadly force, however our review of autopsy data from 29 deaths caused by chokeholds applied by LEO revealed that they can be associated with death and severe cerebrovascular, and central nervous system sequela in both young and older subjects.
Abstract P641: Risk and Predictors of New Cancer Diagnoses After Acute Ischemic Stroke
Authors: Buchman Rutrick Stephanie , Bassi Meenakshi , Atalay Yahya B , Simonetto Marialaura , Shah Bhavan , Lansdale Kelsey , Parikh Neal S , Kamel Hooman , Zhang Cenai , Navi Babak
Published: March 2021

Introduction:
Acute ischemic stroke (AIS) may be the first sign of occult cancer. We aimed to better define the incidence of cancer in the year after AIS and to identify clinical factors associated with new cancer diagnoses.

Methods:
This was a retrospective cohort study using data from the Cornell Acute Stroke Academic Registry (CAESAR) on patients hospitalized at our center with AIS from 2011-2015. Patients with history of cancer were excluded. Through automated electronic data capture and manual abstraction of inpatient and outpatient medical records, we collected data on patients’ demographics, comorbidities, presentation, radiographic characteristics, stroke subtype, and clinical outcomes. Patients were followed for 1 year after the index AIS for a new diagnosis of pathologically-confirmed cancer. Cox hazards regression adjusting for the competing risk of death was used to evaluate associations between clinical factors and incident cancer. Factors significantly associated in multivariable analysis were entered into a risk stratification score, and this score’s discriminatory ability was evaluated by Harrell’s C-statistic.

Results:
After excluding 253 patients with history of cancer, this analysis included 963 patients with AIS. During a mean follow-up of 222 days, 16 patients (1.7%; 95% CI, 1.0-2.7%) were diagnosed with cancer. The most common cancers were lung (n=7) and leukemia (n=4) and the median time to cancer diagnosis was 13 days (IQR, 7-194 days). Among patients with cryptogenic stroke, the 1-year cancer incidence rate was 1.7% (95% CI, 0.6-3.7%). Clinical factors associated with incident cancer in multivariable analysis were venous thromboembolism during the AIS hospitalization (HR, 12.5; 95% CI, 3.3-47.0), unexplained weight loss within 6 months (HR 11.7; 95% CI, 3.3-42.0), and three-territory acute infarcts (HR, 4.1, 95% CI, 1.3-13.4). These factors were used to create a clinical score that had a C-statistic of 0.7 (95% CI, 0.5-0.8).

Conclusions:
In a large urban cohort of AIS, the estimated 1-year incidence of first-ever cancer was 1.7%. Unexplained weight loss, concomitant venous thromboembolism, and three-territory acute infarction pattern may serve as clues to occult cancer with AIS.
Abstract P647: Variations in the Internal Carotid Artery Angle of Origin Are Poorly Explained by Vascular Risk Factors
Authors: Del Brutto Victor J , Dong Chuanhui , Cabral Digna E , Romano Jose G , Gutierrez Jose , Elkind Mitchell S , Sacco Ralph L , Rundek Tatjana
Published: March 2021

Background:
Internal carotid artery (ICA) angle of origin is considered a contributor to atherogenesis because of its influence on hemodynamics. It is controversial if ICA angle variations are causal or consequential to carotid atherosclerosis or vascular risk factors. We aim to determine whether vascular risk factors underly ICA angle interindividual variations.

Methods:
The study included 1,111 stroke-free participants of the population-based Northern Manhattan Study (NOMAS) who underwent ICA angle estimation using B-mode carotid ultrasound (mean age 68.7±8.9 years; 41% were men, 60% Hispanic, 21% Black, and 18% White). Multivariable linear regression models were fit to assess the relationship of ICA angle to vascular risk factors.

Results:
ICA angle was significantly wider on the left compared to the right (26.6 ±15.5 degrees versus 18.6 ±12.9 degrees; p<0.001). In multivariate analyses, left ICA angle was correlated with age (B=0.07; p=0.03), female sex (B=0.09; p=0.004), Black race (B=0.11; p=0.02), and diastolic blood pressure (B=0.16; p<0.001), whereas right ICA angle was positively correlated with body mass index (B=0.07; p=0.04) and physical inactivity (B=0.08; p=0.02), and inversely correlated with low-density lipoprotein level (B=-0.1; p=0.004). Overall, these factors explained less than 5% of ICA angle variance (R
2
=0.0399 on the left; R
2
=0.0197 on the right).

Conclusion:
ICA angle variations are poorly explained by vascular risk factors at the population level. Our results suggest ICA angle is an independent feature that may predispose to atherogenesis.
Abstract P650: Increased Genetic Risk for Venous Thromboembolism is Associated With Early Onset Ischemic Stroke
Authors: Jaworek Thomas J , Gaynor Brady , Xu Huichun , Cole John W , Stine O. C , McArdle Patrick , Kittner Steven J , Mitchell Braxton D ,   Early Onset Ischemic Stroke Consortium
Published: March 2021

Intro:
In the Early Onset Stroke Consortium (EOSC) trans-ancestry analysis we found the ABO locus to be strongly associated with early onset stroke (rs529565, OR=1.10, p-value= 2.01 x 10-12). The lead SNP at this locus has a significantly larger effect size in early onset cases compared to stroke cases after age sixty and is independently associated with venous thromboembolism. This finding, in addition with previously reported candidate gene studies (
F5
,
F11
,
PROCR
), suggests that coagulation and hemostasis related pathways may be a major driver of early onset stroke.

Motivation:
To examine the genetic relationship between VTE risk burden and early onset stroke, we performed a polygenic risk score analysis to determine whether increased genetic risk for VTE was also more strongly associated with early compared to late age of onset stroke.

Methods:
Weighted VTE polygenetic risk scores based on recent GWAS of VTE were calculated for each individual in 7K early onset, under age 60, stroke cases from the EOSC and in 9K late onset, ages 60 and older, stroke cases from SiGN. Logistic regression was performed to test the association between the VTE-PRS score and ischemic stroke outcome controlling for sex and the first ten principal components to account for ancestry. Analyses were stratified by age of onset. Fixed effects meta-analysis was performed to combined results across the analysis strata.

Results:
PRS of VTE was associated with early ischemic stroke (OR=1.11, p-value=0.02) and we saw no association between VTE-PRS and late onset stroke (OR=1.04, p-value=0.5). Early cases had a greater PRS of VTE than late cases (p-value=0.01).

Conclusion:
While VTE has been shown to associate with stroke risk, we observed a greater genetic risk for VTE in early onset ischemic stroke compared to older onset stroke. This complements existing evidence implicating coagulation-related mechanisms as an important genetic mechanism in early onset strokes.
Abstract P654: Predicting Afib in Cryptogenic Ischemic Stroke Patients With Implantable Loop Recorders
Authors: Wee Claribel D , Suryadevara Tejeswi , Vanguru Husitha , Ahmed Rashid , Hawley Danielle , Loveless Stephanie , Singh Avneet , Latorre Gene , Albright Karen C
Published: March 2021

Paroxysmal atrial fibrillation (Afib) detection in cryptogenic stroke is difficult but essential because it changes management. We describe a scoring system that discriminates between cryptogenic ischemic stroke patients with implantable loop recorder (ILR) that were and were not found to have Afib. Consecutive cryptogenic stroke cases from cardiology’s ILR registry for a 2-year period (7/2017-7/2019) were reviewed. We used standardized case report forms to perform chart abstraction. Cases were excluded if ILR was not placed after the index stroke event, stroke etiology workup was not available, or data was incomplete. Patients found to have Afib on ILR were compared to those without evidence of Afib on ILR. We devised a novel scoring system using variables associated with Afib detection and compared its ability to classify Afib detection against CHA2DS2-VASc and LADS. One hundred fifty-seven patients met inclusion criteria. Afib was detected in 12% of cases (9% at 6 months, 10% at 12 months). The median time from ILR placement to Afib detection was 110 days (IQR 37, 507). Median time from Afib detection to the start of anticoagulation was 3 days (IQR 0, 8). The PAL-CrISP score ranges 0 to 7: age (70=0, ≥70=4), history of antihypertensive medication (no=0, yes=2), PR interval (≤200msec=0, >200msec=1). Of those found to have Afib via ILR, 74% (14/19) had a PAL-CrISP score ≥ 6. PAL-CrISP performed better at predicting Afib detection in cryptogenic ischemic stroke patients with ILR (AUC 0.810, 95% CI 0.706-0.913) than CHA2DS2-VASc (AUC 0.650, 95% CI 0.525-0.774) and LADS (AUC 0.745, 95% CI 0.624-0.866). Using only age, home medication review, and an EKG, the novel PAL-CrISP score performs better at predicting Afib detection than the CHA2DS2-VASc and LADS scores in cryptogenic ischemic stroke patients with an ILR.
Abstract P655: Race Differences in 10-Year Mortality After Ischemic Stroke
Authors: Lichtman Judith H , Leifheit Erica C , Wang Yun , Arakaki Andrew , Goldstein Larry B
Published: March 2021

Background:
Few studies report 10-year mortality outcomes after stroke in the US by race. We assessed long-term survivorship by race among elderly ischemic stroke patients.

Methods:
We identified fee-for-service Medicare beneficiaries aged ≥65 years discharged alive from US acute-care hospitals with a principal diagnosis of ischemic stroke from 2005 to 2007. Patients were followed through 2016 to calculate 10-year all-cause mortality, censoring for change in Medicare enrollment. Inverse probability weighting (IPW) was used to assess race differences in mortality. We used logistic regression to calculate the probability of a patient being Black as a function of age, Medicaid eligibility, comorbidities, in-hospital complications, discharge disposition, length of stay, and Medicare payment. We then fit a Cox regression model for the relationship between race and 10-year mortality that adjusted for sex and the inverse probability of being Black.

Results:
There were 744,044 patients discharged alive with stroke (mean age 78.7y, 54.7% women, 85.6% White, 9.9% Black, and 4.5% other race). Black patients tended to be younger and were more often women. There were race differences in comorbidities, with renal failure, dementia, and diabetes more common in Blacks; atherosclerosis and COPD were more common in Whites. The 10-year mortality rate was 75.3% (95% CI 75.2–75.4%) for the overall population, with Blacks having the highest mortality (76.4%, 76.1–76.7%), followed by Whites (75.4%, 75.3–75.5%) and those of other race (70.3%, 69.8–70.8%; Figure). In the IPW analysis, the risk of death within 10 years of stroke was higher for Blacks (RR 1.04, 95% CI 1.03–1.04) but lower for other races (RR 0.92, 95% CI 0.90–0.93) when compared with Whites.

Conclusions:
More than 75% of stroke patients died within 10 years. The 10-year stroke mortality risk was higher for Black stroke patients even after accounting for sociodemographic and index hospitalization factors.
Abstract P657: Soluble Receptor for Advanced Glycation End Products and Subtypes Are Protective Biomarkers of Functional Outcome but Not Those of Recurrence in Acute Ischemic Stroke
Authors: Wang Chunjuan , Pan Yuesong , Li Zixiao , Meng Xia , Li Hao , Jiang Yong , Wang Yongjun
Published: March 2021

Background and purpose:
Soluble isoforms of receptor for advanced glycation end products (sRAGE) and subtypes have been recognized as contradictory biomarkers of ischemic stroke. We sought to investigate whether the plasma levels of sRAGE and subtypes can predict unfavorable outcome and recurrence in acute ischemic stroke patients.

Methods:
The data used in this study was from the Third China National Stroke Registy (CNSR III), which was a nationwide, prospective cohort study to register acute ischemic stroke and transient ischemic attack patients. Plasma levels of sRAGE and subtypes were tested by enzyme-linked immunoabsorbent assay (ELISA) method and demonstrated by quartiles. Cox proportional hazards model was used to analysis the association of sRAGE and subtypes with unfavorable outcomes or stroke recurrence at 3- and 12-month in acute ischemic stroke patients, respectively. Unfavorable outcome was defined as modified Rankin Scale (mRS) 3-6.

Results:
Three thousand one hundred and eighty-nine acute ischemic stroke patients were included and tested for plasma level of sRAGE and subtypes (cRAGE and esRAGE) in this study. Mean age was 62.8±11.5 years and 2161 (67.8%) were male. At 3- and 12-month, there were 426 (13.5%) and 409 (13.1%) patients with an unfavorable outcome and 185 (5.9%) and 293 (9.2%) patients with stroke recurrence, respectively. Refered by quartile one of sAGRE, the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs) of unfavorable outcomes in quartile two to four were 0.81 (0.59-1.10), 0.66 (0.48-0.92) and 0.65 (0.47-0.91) at 3-month and 0.79 (0.58-1.08), 0.61 (9.44-0.85) and 0.66 (0.48-0.91) at 12-month; those of stroke recurrence in quartile two to four were 0.99 (0.66-1.49), 0.99 (0.66-1.49) and 1.02 (0.68-1.54) at 3-month and 1.05 (0.76-1.45), 0.95 (0.68-1.32) and 1.07 (0.77-1.48) at 12-month, respectively. Same data trends were found in subtypes cRAGE and esRAGE.

Conclusion:
Plasma levels of sRAGE and subtypes were protective biomarkers of unfavorable outcomes but not those of stroke recurrence in acute ischemic stroke patients.
Abstract P663: Polygenic Risk Scores for Plasma Levels of Fibrin D-Dimer and Tissue Plasminogen Activator Are Associated With Non-Lacunar Stroke
Authors: Addissie Yonit A , Gaynor Brady , Jaworek Thomas , Xu Huichun , Stine Colin O , Cole John W , Mitchell Braxton D , Kittner Steven J ,   On behalf of the Early-Onset Ischemic Stroke Consortium
Published: March 2021

Introduction:
Plasma concentrations of prothrombotic factors such as fibrinogen have previously been associated with ischemic stroke risk. To extend this observation, we examined the association of polygenic risk scores (PRS) for increased plasma levels of thrombosis-related factors with ischemic stroke. Our hypotheses were that these PRS would be more associated with early than late onset stroke and with non-lacunar than lacunar stroke.

Methods:
We identified 9053 late onset (≥ 60 years) stroke cases from the NINDS International Stroke Genetics Consortium (SiGN) with 24804 controls and 6594 early onset (< 60 years) stroke cases from the Genetics of Early Onset Ischemic Stroke Consortium with 30561 controls. We identified previously known loci associated with plasma levels of four thrombosis-related factors: fibrinogen, fibrin D-dimer, tPA and PAI-1 from prior GWAS studies and developed genome-wide PRS for plasma concentrations of these factors. We then used logistic regression to test the association of these scores with risk of stroke and stroke subtype.

Results:
PRS for fibrin D dimer levels were associated with increased risk for all stroke and specifically for older (p = 0.019), but not younger (p = 0.22) onset stroke. PRS for tPA levels were also marginally associated with older (p = 0.06), but not younger (p = 0.24) onset stroke. Genetic risk scores for both D dimer and tPA were associated with non-lacunar stroke (Table 1). Further analyses stratified by age revealed PRS for D dimer to be significantly associated with non-lacunar stroke (but not lacunar stroke) in both late and early onset cohorts. PRS for fibrinogen and PAI-1 were not associated with stroke.

Conclusion:
Genomic risk scores for thrombosis-related factors including D dimer and tPA levels were associated with risk for ischemic stroke, and specifically, non-lacunar stroke.
Abstract P673: The Obesity Paradox in Patients Hospitalized for Ischemic Stroke
Authors: Velazquez Genaro , Shaka Hafeez , Marcos-Abdala Hernan G. , Akuna Emmanuel
Published: March 2021

Introduction:
Even though Obesity, as measured by BMI
>
30.00 kg/m
2
, is a established risk factor for ASCVD, it hasn’t been proven as a risk factor for adverse outcomes in patients with diagnosis of ischemic stroke. Our study sought to compare outcomes for ischemic stroke hospitalizations in patients with and without Obesity.

Methods:
A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 71,473,874who had ischemic stroke as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, treatment with mechanical thrombectomy, treatment with tPA, and complications like respiratory failure requiring intubation, pulmonary embolism (PE), DVT, NSTEMI and sepsis. Multivariate regression analysis was done to adjust for confounders.

Results:
The in-hospital mortality for patients with ischemic stroke was 42 145 overall. Compared with patients without obesity, patients with Obesity had a lower odds of in- hospital mortality (aOR 0.85, 95% CI 0.79-0.93, p<0.001) when adjusted for patient and hospital characteristics. We found that patients with ischemic stroke and obesity had decreased length of hospital stay and higher odds ratio of treatment with mechanical thrombectomy, treatment with tPA, and higher odds ratio of complications like respiratory failure requiring intubation and pulmonary embolism (PE). No significant difference in other secondary outcomes (DVT, NSTEMI and sepsis).

Conclusion:
There is convincing evidence supporting the existence of the “obesity paradox” in patients with ischemic stroke. Several stroke-associated mechanisms, like autonomous nervous activation and pro-inflammatory cytokine release in addition to other factors like impaired feeding and inactivity cause accelerated tissue degradation and overall weight loss. It is thought that obese patients with better metabolic reserve may be less affected from this unfavorable metabolic dysregulation as compared to underweight patients. Nevertheless, further studies are needed in order to identify factors responsible for this paradox.
Abstract P679: Ankle-Brachial Index is Independently Associated With Functional Outcome After Stroke
Authors: Dantas Moises C , Oliveira Alice S , Velloso Liz U , Lucio Marcio J , Pimenta Milla D , Leopoldino Osvaldo C , Medeiros Rafaella C , Lima Junior Tairone M , Santana Tiffany A , Alcantara Yasmin F , Jesus Pedro A , Farias Daniel S , Oliveira-Filho Jamary
Published: March 2021

Introduction:
The ankle-brachial index (ABI) is the ratio between systolic blood pressure of the upper and lower limbs. A low ABI (
<
0.9) is associated with increased risk of cardiovascular and stroke outcomes. However, ABI relevance for functional outcomes is unknown.

Objective:
We aimed to investigate if low ABI is associated with functional outcome in stroke patients.

Methods:
Consecutive patients with imaging-confirmed ischemic stroke were recruited from a public hospital in Salvador, Brazil. Demographic and cerebrovascular risk factor data were collected prospectively. We used NIH stroke scale to quantify stroke severity and ABI was measured on admission. Patients were followed for 90 days and functional outcome was assessed by modified Rankin Scale (mRS). Poor outcome was defined as a mRS = 3 to 6. Logistic regression was used to adjust for potential confounders of poor outcome.

Results:
We recruited 376 patients with ischemic stroke between October 2018 and October 2019, mean age 64 +/- 13 years, 189 (49%) female. Median ABI was 1.06 (interquartile range - IQR 0.93 to 1.13). After 90 days, 209 (56%) patients had poor outcome. Low ABI was more frequent in patients with poor outcome (38% vs 18%, p=0.0001). After adjustment for age, sex and cerebrovascular risk factors, low ABI remained a significant predictor of poor outcome (odds ratio 2.10; 95% confidence interval 1.24 - 3.55, p=0.006).

Conclusions:
Low ABI is an independent predictor of poor outcome in acute stroke patients. Assessment of ABI on admission is clinically useful as a prognostic tool and should be more routinely implemented.
Abstract P68: Disrupted Electrophysiological Sleep in Critically ill Stroke Patients: Does it Matter?
Authors: Dutta Rebecca , Markun Leslie , Sampat Ajay , Ng Kwan L , Yee Alan H
Published: March 2021

Mounting evidence suggest that poor sleep quality may impact outcome following stroke. While sleep disturbances are common among critically ill patients, little is known about sleep characteristics in neurocritical stroke patients. We examined sleep characteristics in acute stroke patients admitted to an intensive care unit (ICU) compared to those admitted for non-stroke conditions.

Methods:
Retrospective analysis of critically ill patients who underwent continuous electroencephalographic (cEEG) monitoring in the ICU from 2018-19. Sleep was scored based on American Academy of Sleep Medicine-defined EEG criteria. EEG and clinical characteristics [NIH Stroke Scale (NIHSS), Hunt and Hess (HH) Grade, and ICH Score] were collected. Primary outcomes were based on modified Rankin Scale (mRS) scores of which 2 or less was considered favorable. Differences were assessed using Chi-Square test.

Results:
228 ICU patients underwent cEEG; mean age was 58 years (range 18-91) and 57% were male. 61 (27%) were admitted for acute stroke (16 ischemic, 17 aneurysmal subarachnoid hemorrhage (aSAH), 27 non-traumatic intracerebral hemorrhage (ICH)). The other 167 critically ill patients were admitted for medical, surgical, or non-stroke related neurological conditions. In those with stroke, mean NIHSS scores for ischemia, mean ICH Score for ICH, and mean HH for aSAH were 18.78, 2.12, and 3.36, respectively. Rates of attaining any sleep were similar between stroke (27.9%) and non-stroke patients (26.9%). 29.4% of stroke patients who achieved sleep had good outcomes compared to only 9.1% that did not (χ
2
(1)=2.79, p=0.095). In stroke patients that achieved sleep, 52.9% of patients reached Stage N1, 47.1% Stage N2 and none reached Stages N3 or REM. In the non-stroke cohort, 46.6% who achieved sleep had good outcomes compared to 26.2% who did not (χ
2
(1)=6.34, p=0.012). Of these, 37.8% reached Stage N1 sleep, 60% Stage N2, 2.22% Stage N3, and none reached Stage REM.

Discussion:
Critically ill stroke and non-stroke patients have disrupted electrophysiological sleep, and none reach REM stage. A trend towards improved outcome in stroke survivors was observed in those who slept. The association between sleep variability, stroke mechanism, and functional outcome needs further exploration.
Abstract P691: Clinical Significance of Systolic and Diastolic Blood Pressures as Stroke Risks After Kidney Transplantation
Authors: Tantisattamo Ekamol , Leelaviwat Natnicha , Songtanin Busara , Polpichai Natchaya , Saowapa Sakditad , Lopimpisuth Chawit , Vutthikraivit Possawat
Published: March 2021

Introduction:
SBP is commonly utilized for BP control in stroke, but the clinical significance of DBP in kidney transplant recipients (KTR) is unknown.

Hypothesis:
We hypothesize that DBP at the time of stroke presentation is also associated with risk factor of stroke in KTR.

Methods:
This is a nested case-control study using a closed cohort of end-stage kidney disease patients undergoing kidney transplantation (KT) over a 12-year period. Stroke was diagnosed from brain imaging lesions consistent with localized neurological deficits. One case was matched with three controls based on age and date of KT identified at the same time when the first episode of CVA of each case occurred (incidence density sampling method).

Results:
Of all 752 KTR, 5 stroke cases and 15 controls were identified during the last 2 years of a study period. Mean age±SD was 45±16 VS 47± 12 years. Mean SBP of cases and controls were not significantly different (SBP±SD: 159±24 VS. 135±29 mmHg, p 0.109); whereas, mean DBP of the cases were significantly higher (DBP±SD: 93±7 and 76±13 mmHg; p 0.015) (Figure 1). Compared with the controls, cases’ SBP was 24 mmHg greater, but was not significant; whereas, DBP was 17 mmHg significantly higher (β 24.61; p 0.109; 95%CI -6.07, 55.29) and (β 17; p 0.015; 95%CI 3.69, 30.31). After adjusted by gender, race, body mass index, presence or absence of diabetes, hyperlipidemia, coronary artery disease, and atrial fibrillation, duration after KT, serum calcium and phosphorus, both SBP and DBP were 61 and 28 mmHg significantly higher, respectively among cases compared to the controls (β 61.11; p 0.011; 95%CI 20.31, 101.92) and (β 28.11; p 0.001; 95%CI 16.23, 39.10).

Conclusion:
Although SBP is known to be associated with stroke, DBP at the time of presentation for stroke is also associated with stroke in KTR. Epidemiological studies comparing SBP and DBP for outcomes of stroke in this population will further identify appropriate BP control and may change clinical practice.
Abstract P695: Rural-Urban Differences in Functional Outcomes After Acute Therapy for Stroke
Authors: Shen Jeffrey , Budhraja Deepika , Shah Seeta , Martin Kimberly , Lin Chen
Published: March 2021

Introduction:
The Southeastern United States, known as the “the stroke belt,” has the highest stroke mortality rate in the country. One possible reason is the high proportion of its residents living in rural areas. Studies suggest stroke care is worse for patients living in rural areas, and they are less likely to receive acute stroke therapy (intravenous thrombolysis or endovascular therapy), leading to worse outcomes. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received acute stroke therapy.

Methods:
We performed a retrospective analysis of a tertiary care academic hospital in the Southeastern US, the University of Alabama at Birmingham. Patients admitted with imaging-confirmed ischemic stroke and had acute stroke therapy between 2014 and 2018 were included for analysis. Individuals were classified as rural or urban dwelling based on US Department of Agriculture’s 2010 Rural-Urban Commuting Area Codes. Clinical and demographic characteristics were collected from the chart. Stepwise logistic regression models were performed with these variables to compare good (mRS 0-1) vs poor (mRS 2-6) functional outcomes.

Results:
There were 232 patients included in the study (185 urban, and 47 rural). There were no significant differences between groups in age (urban 64.5±15.1; rural 66.2±14.7), gender (urban: 56% male 44% female, rural: 51% male 49% female), or proportion of African-Americans (33% of urban group and 25% of rural group). Mean baseline NIH stroke scale was higher in rural patients than urban (17.0 vs 14.8 respectively, p-value=0.03.). In logistical regression models for good functional outcome (mRS 0-1) at 90-days, analysis of factors including rural/urban status, gender, age, insurance, transfer, and acute stroke therapy, revealed only older age as a significant factor (OR 0.97, 95% CI 0.95-0.99).

Conclusions:
Our study demonstrated no significant differences in functional outcome between patients from urban and rural locations after receiving acute therapy for treating ischemic stroke. Importantly, only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas can recover similarly to those from urban areas.
Abstract P697: Vasomotor Symptoms of Menopause Increase Stroke Risk in Migraineurs
Authors: Figurelle Morgan , Meyer Dawn M , Perrinez Emily , Rapp Karen , Wells Rebecca , Guzik Amy K , Hemmen Thomas M
Published: March 2021

Introduction:
The relationship between migraine and stroke, especially in migraine with aura, has been well-established. There is emerging evidence that vasomotor symptoms (VMS) such as hot flashes, flushing and night sweats associated with menopause increases the risk of vascular events, especially in the perimenopausal period. The aim of this study was to compare vascular risk factors in perimenopausal females with and without migraine with concomitant acute ischemic stroke (AIS).

Methods:
In this IRB approved study, we examined patient level data using the SlicerDicer function within Epic at a large, academic, comprehensive stroke center from 1/1/2015 to 1/1/2020. Inclusion criteria included female sex, age 42-65 years, and hospital diagnosis code of AIS. Hemorrhagic stroke, TIA, vasculopathy, and endocarditis associated strokes were excluded. Perimenopausal was defined as age ≥42 and ≤65 years. Hormonal and menopausal status was not available. We compared rates of co-morbidities by ICD10 codes of subjects with and without migraine using descriptive statistics and Chi squared analysis.

Results:
We identified 2296 (90%) women without migraine (Group 1) and 243 (10%) with migraine (Group 2) admitted for AIS. The five most common risk factors for AIS in group 1 were hypertension (56%), hyperlipidemia (37%), diabetes (30%), obesity (23%) and atrial fibrillation (11%). VMS was coded in 8% and tobacco use 7%. In group 2 we found hypertension (50%), hyperlipidemia (42%), migraine with aura (31%), obesity (23%), diabetes (20%). VMS was coded in 14%, atrial fibrillation in 12%, and tobacco use in 6%. Group 2 patients were more likely to have VMS (p = 0.008) and less likely to have diabetes (p=0.001). There were no other significant differences identified.

Conclusions:
Vasomotor symptoms in menopause are a significant risk factor for AIS in perimenopausal women with migraine. VMS should be assessed for clinically and included as a risk factor for stroke, especially in those with additional vascular risk factors. Future studies should include a diverse sample to assess the impact of VMS in a heterogeneous population.
Abstract P701: Depression, OSA, and Anxiety (DOA) Related Healthcare Burden Amongst Stroke Survivors- A National Estimate
Authors: Veluri Nikhila , Sheikh Batool , Gude Jayasudha , Subhedar Rashmi , Jain Pratik , Bhela Jatminderpal , Bangash Fariha , Hsieh Ya-Ching , Zhang Michelle , Patel Urvish K , Mansuri Zeeshan , Shah Shamik , Parikh Tapan
Published: March 2021

Background:
Evaluation of mental health of acute ischemic stroke (AIS) patients is crucial to reduce health care burden.

Objective:
Aim of this study was to evaluate the prevalence and outcomes [morbidity, disability (APRDRG loss of function) and discharge disposition] of DOA amongst AIS patients.

Methods:
A cross-sectional study was conducted on Nationwide Inpatient Sample from 2003-2017. Adult primary hospitalizations with AIS were extracted and concurrent DOA were identified using ICD-9/10-CM codes. Weighted analysis using Chi-square test and mixed-effect multivariable survey logistic regression was performed to evaluate prevalence and role of DOA to predict the outcomes. Definitions of outcomes were mentioned in
Table 1
.

Results:
Out of a total 5,690,773 AIS hospitalizations, 2.65%, 3.1% and 4.37% had depression, OSA, and anxiety, respectively. In AIS patients, females had higher prevalence of depression [3.43 vs 2.25%] and anxiety [5.92 vs 3.04%] and lower prevalence of OSA [2.21 vs 4.40%] in comparison to males. (p<0.0001) Caucasians had a higher prevalence of depression [3.11 vs 2.12 vs 2.84 vs 1.81 vs 2.54%], OSA [3.43 vs 3.27 vs 2.42 vs 1.60 vs 3.24%], and anxiety [5.26 vs 2.48 vs 3.75 vs 2.13 vs 3.59%] in comparison to AA, Hispanic, Asian, and Native American, respectively. (p<0.0001) Depressed patients had a higher prevalence of morbidity (9 vs 8 vs 5 vs 7%), disability [46 vs 46 vs 35 vs 37%], transfer to non-home [69 vs 58 vs 61 vs 63%] in comparison with OSA, anxiety and non-DOA patients, respectively. (p<0.0001) Depression was associated with 40% higher chance of severe disability (aOR 1.4; 95%CI 1.38-41), morbidity (1.36; 1.33-1.38) and discharge to non-home (1.54; 1.52-1.56). OSA and anxiety had higher odds of non-home discharge amongst post-AIS hospitalizations.
(Table 1)

Conclusion:
DOA is associated with poor outcomes amongst post-AIS patients. Prompt recognition by screening and timely management of DOA may mitigate the adverse outcomes.
Abstract P703: Association of Anemia With Functional Outcomes in Patients With Mechanical Thrombectomy
Authors: Nisar Taha , Abu-hadid Osama , Tofade Toluwalase , Shapouran Sara , Memon Muhammad Zeeshan , Singla Amit , Khandelwal Priyank
Published: March 2021

Introduction:
Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke. We aim to investigate the association of anemia upon presentation with functional outcomes in patients who undergo mechanical thrombectomy (MT).

Methods:
We performed a retrospective chart review of patients who underwent MT for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. Anemia was considered a dichotomous categorical variable with a cutoff point of hemoglobin <12.0 g/dL in women and <13.0 g/dL in men, as per the definition of the World Health Organization. A binary logistic regression analysis was performed, controlling for age, pre-treatment-NIHSS, ASPECTS ≥6, TICI score ≥2b, onset to recanalization time, and administration of intravenous-alteplase (IV-rtPA), with the presence of anemia as the predictor. The primary outcome was a good functional outcome at 3-months (mRS of ≤1). The secondary outcomes were 3-month mortality, sICH (ECASS-II criteria), and infarct volume on follow-up CT Head.

Results:
177 patients met our inclusion criteria. The mean age was 64.34±15.16 years. 93 (52.54%) patients were men. 34 (19.21%) patients had 3-month mRS≤1. 11 (6.21%) patients developed sICH. Among men, there was a significant association of anemia with lesser chance of good functional outcome (5.89% vs.23.73%; OR, 6.1; 95% CI, 1.3-30.5; P 0.028), higher mortality (52.94% vs.30.51%; OR, 2.9; 95% CI, 1.1-7.8; P 0.038), and a larger infarct volume (106.12±109.78mls vs.73.02±74.36mls.; OR, 1.1; 95% CI, 1.1-1.1; P 0.032), but not with sICH (5.89% vs.5.26%; OR, 1.6; 95% CI, 0.2-12.2; P 0.681). Among women, there was no significant association of anemia with any outcome measures: mRS ≤1 (25% vs.31.25%; OR, 0.84; 95% CI, 0.27-2.59; P 0.754), mortality (25% vs.23.08%; OR, 1.26; 95% CI, 0.4-3.97; P 0.693), infarct volume (60.08±94.46mls vs.69.05±97.74mls.; OR, 1; 95% CI, 1-1.01; P 0.981), and sICH (9.37% vs.5.89%; OR, 1.52; 95% CI, 0.26-8.88; P 0.643).

Conclusions:
Our study demonstrates a gender difference in outcomes in patients with anemia at presentation who undergo MT. In our cohort, men had an association between anemia and mRS≤1, mortality, and a larger infarct volume, unlike women.