Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS
Authors: Romano Jose G. , Gardener Hannah , Campo-Bustillo Iszet , Khan Yosef , Tai Sofie , Riley Nikesha , Smith Eric E. , Sacco Ralph L. , Khatri Pooja , Alger Heather M. , Mac Grory Brian , Gulati Deepak , Sangha Navdeep S. , Craig Jeffrey M. , Olds Karin E. , Benesch Curtis G. , Kelly Adam G. , Brehaut Scott S. , Kansara Amit C. , Schwamm Lee H. , Grory Brian Mac , Oka Mayumi , Roels Christina , Chang Cherylee W. J. , Moran Jennifer , Lanciano Nicholas , Romero Charles E. , Salvatore David , Shah Neel , Leacock Rodney , Rochester Angel , Martin Jerry C. , Grover Vikas , Malik Maheen , Logan William R. , Khan Muhib A , Babu Arun , Carlson Jestin , Vidal Gabriel , Lynch Jennifer , Kirchoff Kathryn , Rasmussen-Winkler Jennifer , Thompson Gary , Martino Stephen , Gordon-Perue Gillian L. , Gildersleeve Kasey , Parsons Timothy C. , Chen John W. , Lombardi David , Malik Amer , Guzik Amy , Hoesch Robert , Altschul Dorothea , Salgado Miran , Acosta Indrani , Neill Terry A. , Chowdhary Abhineet , Romero Jose Rafael , Assad Refat , Sugg Rebecca , Alvi Muhammad M. , Hartman Jonathan , Garg Ankur , Given Curtis , Hilburn Jeffrey , Commichau Christopher , Hahm Changsoo , Pulido Angel , Ramezan-Arab Nima , Khanna Anna , Williams Armistead , Reddy Ratna , Desai Bhupat , Ufford Laurence , Jones Keith O. , Martino Stephen , Wise Elizabeth H. , Chaudhary Gauhar , Hanna Joseph , Marden Franklin , Arora Ajay , Reichwein Raymond , Matmati Kelly , Owada Kumiko , Masih Ashish , Shepherd Larry , Gancher Stephen , Smith Matthew , Mazzola Joseph , Plyler Edward , Napier James , Alshekhlee Amer , Ramachandran Tarakad , Jorolemon, David Michael , Collin Maloney Padalino , Dhakal Laxmi P. , Milling Truman J. , Shownkeen Harish , Cullis Paul A. , Mueed Sajjad , Levine Steven R. , Milling Truman J. , Nayyar Kanwal , Dotson Rose , Coleman Elisheva , Gadhia Rajan , Lewis Paul W. , Sajjad Rehan , Katramados Angelos , Kothari Rashmikant , Chang Fen Lei , Desai Kinjal , Reese Gary , Jadhav Ashu , Saver Jeffrey , Miller Janice A. , Tenser Matthew S. 
Published: May 2021

Background and Purpose:
Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population.

Methods:
This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase.

Results:
A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded (<1%).

Conclusions:
A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02072681.