Abstract WP162: Outcomes and Long-Term Mortality After Ischemic Stroke in the Young: A Preliminary Analysis From the Greater Cincinnati/Northern Kentucky Stroke Study

Abstract

Introduction: There is a trend towards ischemic stroke (IS) occurring at younger ages. We sought to better characterize outcomes and mortality over 3 years by age at time of stroke within a large, biracial population. Methods: Incident IS were ascertained during the 2005 and 2010 study periods of our population based epidemiology study via ICD-9 codes 430-436. Research nurse coordinators performed medical record abstraction on all potential events, which were then adjudicated by study physicians as case/not a case. Abstractions included discharge or 30-day outcomes (if available) as measured by modified Rankin scale (mRS). Mortality for IS events out to 3 years was determined via all available information including the Social Security Death Index. We compared the outcomes and post-stroke mortality by 20-55 (young stroke) versus >55 years, and by decade. Descriptive statistics are reported as n (%), and mean (SD) or median (25 th and 75 th %ile) as appropriate. The primary analysis examined the effect of age, race and sex using regression, life table and proportional hazards models. Results: Results are shown in the table. IS in the young occurred more frequently among black cases. The median rNIHSS was 3 although the NIHSS distribution trended towards more severe IS in the older age group. Young strokes had lower baseline and 30-day mRS. The mortality rate was greater in the older ages, at each time point and overall. After adjusting for race, sex and stroke severity the hazard ratio for lower survival in the strokes >55 years old was 4.03 (95% CI 3.15, 5.17). Conclusion: IS patients < 55 years old are less likely to die after stroke. Young stroke occurs in demographically different populations than older strokes and this group would benefit from further study.

Development and Validation of the Michigan Chronic Disease Simulation Model (MICROSIM)

“…Event types were randomly assigned while maintaining the stroke vs. MI risk distribution by determining whether a [0, 1) random uniform number was below that partition threshold, assigning a stroke if so or an MI if not. Fatal vs. non-fatal CVD event determinations were made stochastically by determining whether another [0, 1) random uniform number was less than the case fatality estimates for stroke (0.15) 26–29 and MI (0.13). 30…”

Development and validation of the Michigan Chronic Disease Simulation Model (MICROSIM)

“…ASCVD and events were randomly classified as stroke vs. MI using this probability. Fatal vs. non-fatal CVD event determinations were made by randomly assigning mortality for stroke (0.15) [34][35][36][37] and MI (0.13) [38].…”

“…This assumption can be modified within the existing MICRO-SIM treatment framework by specifying alternate BP treatment effects (e.g. reducing BP every wave on treatment by 5/3 mm Hg, without updating subsequent risk factors), but the default is to apply a BP treatment at one wave and then subsequent update BP via changes in risk factor models over time [2,17,24,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”