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JACC March 20, 2018

Volume 71, Issue 11

Prevention
INITIAL STROKE SEVERITY IS A CRUCIAL PREDICTOR FOR HEMORRHAGIC STROKE- AND
ISCHEMIC STROKE-RELATED MORTALITY
Poster Contributions
Poster Hall, Hall A/B
Monday, March 12, 2018, 9:45 a.m.-10:30 a.m.

Session Title: Smells Like We’re on to Something: Prevention Potpourri

Abstract Category: 32. Prevention: Clinical
Presentation Number: 1303-415

Authors: Mark Alberts, Jennifer H. Lin, Yen-Wen Chen, Emily Kogan, Kathryn Twyman, Siddhant Deshmukh, Dejan Milentijevic, Janssen
Scientific Affairs, LLC, Raritan, NJ, USA
Background: Stroke severity, as measured by the National Institutes of Health Stroke Scale (NIHSS) score, has been used to predict
mortality in ischemic stroke (IS). Its ability to predict mortality in hemorrhagic stroke (HS) is unclear. This study examined the use of real-
world data to assess IS and HS severity in relation to all-cause mortality.
Methods: This retrospective cohort study using Optum® integrated data (2007-2016) grouped newly-diagnosed IS or HS patients by
severity, based on a NIHSS score imputed by 100 clinically relevant predictors selected by a random forest method. Overall survival (OS)
was assessed by Kaplan-Meier analysis with a log-rank test.
Results: In all 2,247 HS and 9,071 IS patients were classified into 4 stroke severity groups. The severity distribution and Charlson
comorbidity index were similar for both HS and IS. Kaplan-Meier analysis showed HS and IS had a similar OS profile across severity. OS
was significantly shorter in the more severe groups (p<0.001, HS and IS). At 1 month from diagnosis, mortality was >85% in the severe
stroke group (OS: 6%, HS; 15%, IS [Severe]; 34%, HS; 37%, IS [Moderate-to-severe]; 86%, HS; 87%, IS [Moderate]; 91%, HS; 94%, IS
[Minor]). The likelihood of death in the 2 most severe groups was >10-fold over the minor stroke severity group.
Conclusion: This observational study supports a strong association between stroke severity and OS regardless of stroke type,
underscoring the importance of differentiating stroke by severity in managing patients.