Welcome to the WSC 2022 Interactive Program
The congress will officially run on Singapore Standard Time (SGT/UTC+8)
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*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
SOLUBLE ST2 IS A PREDICTOR OF POOR FUNCTIONAL OUTCOME IN ACUTE ISCHEMIC STROKE
Abstract
Background and Aims
Circulating blood biomarkers involved in the molecular pathways of stroke can help in the prognosis of acute ischemic stroke (AIS). We assessed the predictive values of plasma soluble serum stimulation-2 (sST2), matrix metalloproteinase-9 (MMP-9) and Claudin-5 in AIS across three timepoints.
Methods
Plasma samples of consecutive AIS patients collected at baseline, 12 h and 24 h from stroke onset were assessed using commercially available immunoassays. Stroke severity was assessed using National Institutes of Health Stroke Scale (NIHSS). Functional outcome was assessed at 90 days using modified Rankin Scale (mRS), with scores 3 to 6 categorized as poor outcome. Receiver operating characteristic curves and multivariable logistic regression were conducted to determine the diagnostic accuracy of the test.
Results
We enrolled 108 patients in the study. Mean age of the population was 62.3±11.7 years and 70% were men. Median NIHSS score was 12 (IQR 10). High baseline glucose levels, systolic blood pressure, baseline NIHSS, low ASPECTS (Alberta Stroke Program Early CT Score), and hemorrhagic transformation were associated with poor outcomes. Elevated sST2 at 24 h positively correlated with poor outcome (84.9±105.8 ng/mL;P=0.004) however, no significant association was reported with MMP-9 (P=0.086) and Claudin-5 (P=0.2) although increased expression of the markers was observed at 12 h. Multivariate logistic regression showed that sST2 levels ≥71.8 ng/mL at 24 h, with a specificity of 96.9%, emerged as an independent predictor of poor functional outcome (OR: 6.44, 95% CI: 1.40-46.3;P=0.029).
Conclusions
Elevated sST2 assessed within 24 hours from onset is an independent predictor of short-term functional outcome in AIS.
LONG-TERM MORTALITY AFTER ADMISSION FOR STROKE BETWEEN 2010-2020: OBSERVATIONAL DATA FROM THE AUSTRALIAN STROKE CLINICAL REGISTRY
Abstract
Background and Aims
Data regarding temporal changes in mortality is useful to assess impacts from improvements to stroke care. We assessed changes in 1-year and 5-year survival after stroke using data from the Australian Stroke Clinical Registry (AuSCR).
Methods
The AuSCR is used to monitor the quality of acute care and outcomes for patients admitted with stroke, with annual linkage to national death registrations. Data for direct admissions (e.g. excluded transfers/in-hospital stroke) between 2010 (8 hospitals) and 2020 (62 hospitals) were evaluated for adults aged 18+ years and by stroke type (ischaemic or intracerebral haemorrhage [ICH]). Multivariable Cox proportional hazards regression was used to evaluate differences in 1-year and 5-year survival between years.
Results
Overall 94,780 adult admissions (72 hospitals) were assessed (mean age 73 years, 55% male, 66% ischaemic). The proportion who died within 1 year was 19% (range: 23% in 2012 to 14% in 2020; and within 5 years 44% (2010: 47% and 2014: 41%). More people died following ICH (1 year: 42%; 5 years: 63%) than ischaemic stroke (1 year: 19%; 5 years 45%). Adjusted hazard of death at 1 year was significantly different between 2010 and 2020 (hazard ratio [HR]: 0.65, 95%CI 0.57, 0.74) which was explained by ischaemic stroke (hazard ratio 2020: 0.58, 95%CI 0.50, 0.68) and not ICH (HR: 0.97, 95%CI 0.73, 1.28. There were similar findings for 5-year hazard of death (ischaemic HR: 0.84, 95%CI 0.75, 0.94, ICH non-significant).
Conclusions
Within Australia, 1-year and 5-year mortality after stroke has declined over 10 years, explained by improved survival after ischaemic stroke.
QUALITY AND OUTCOME OF ACUTE CARDIO-CEREBROVASCULAR DISEASE CARE AT THE GOVERNMENT-INITIATED REGIONAL CARDIO-CEREBROVASCULAR DISEASE CENTER
Abstract
Background and Aims
In 2008, the Ministry of Health and Welfare of South Korea launched the Regional Cardio-cerebrovascular Disease Center (RCCVC) program to reduce the regional disparity of stroke incidence and mortality nationwide. From 2008 to 2018, 14 RCCVCs were installed and the established RCCVCs operated independently for stroke management in each region.
Methods
We evaluated the outcomes of acute stroke management after the RCCVC program was introduced. We analyzed in combination with the data of Korea Disease Control and Prevention Agency's Acute Stroke Quality Assessment Program and the data of the Health Insurance Review and Assessment Service evaluated in 299 acute stroke care hospitals in 6 rounds from 2010 to 2018. The hospitals were analyzed by dividing them into RCCVC, non-RCCVC, comprehensive stroke centers (CSC) in Seoul, and non-CSC in Seoul. The outcome measures were defect-free stroke care and mortality rate.
Results
Among 94,976 acute stroke cases (mean age, 67±14 years, male, 55%), 69,997 (73.7%) were ischemic strokes. Defect-free care increased from 50.2% in 2010 to 86.0% in 2018 in RCCVCs, which significantly reduced the gap with CSC in Seoul (62.1% in 2010, 88.0% in 2018). The 1-year mortality rate decreased from 16.4% in 2010 to 14.4% in 2018 in RCCVCs, similar to that in CSC in Seoul (16.9% in 2010, 13.1% in 2018). The 1-year mortality rate of the RCCVCs was significantly reduced compared to that of the non-RCCVC. (OR 0.88, 95% CI 0.78-0.99, p=0.037).
Conclusions
The RCCVC program has improved acute stroke management and outcomes and contributed to reducing regional disparity.
PRESENCE OF EMBOLIC SOURCE IN CENTRAL RETINAL ARTERY OCCLUSION PREDICTS FAVORABLE OUTCOME
Abstract
Background and Aims
Although thromboembolism is the most common cause of central retinal artery occlusion (CRAO), 38~50% remain unknown etiology, suggesting that they could have a different pathomechanism. Little is known about functional outcomes according to the etiologies. Here, we investigated the visual outcome of the CRAO with and without the presence of embolic source.
Methods
Patients with CRAO within 7 days of symptom onset between 2000 and 2021 were reviewed retrospectively. Initial VA (visual acuity), 1-month VA, use of thrombolytics, onset-to-visit time, comorbidities, and brain images were reviewed. CRAO with embolic source was defined when evidence of cardioembolism, large artery atherosclerosis, diseases causing hypercoagulability, or carotid dissection. CRAO without embolic source was defined when there was no evidence of embolic source or the presence of vasculitis. Improvement of VA was defined by ∆ logarithm of the minimum angle of resolution (LogMAR) ≤ -0.3 at 1 month.
Results
Of 114 patients, the median onset-to-visit time was 24h [IQR 8.4–72]. VA was improved in 38.6% (initial and 1-month LogMAR, 2.2 ± 0.5 vs. 2.0 ± 0.6, n=44). Embolic sources were identified in 63 (55.3%) patients, and they were more commonly associated with VA improvement than no improvement (70.5% vs. 55.3%, P=0.017). In a multivariable logistic regression analysis, CRAO with embolic source independently predicted VA improvement (OR 2.52, 95% CI 1.04–6.09), while intraarterial thrombolysis did not.
Conclusions
CRAO with the presence of an embolic source was closely related to the functional improvement of VA. This finding might be linked to the difference in etiological mechanisms of CRAO.
CIRCADIAN TIME OF ISCHEMIC STROKE ONSET AFFECTS PRESENTING SEVERITY, ACUTE PROGRESSION, AND LONG-TERM OUTCOME
Abstract
Background and Aims
Preclinical data suggest circadian variation in ischemic stroke progression, with more active cell death and infarct growth in rodent models with inactive phase (daytime) than active phase (nighttime) stroke onset. We aimed to examine the association of stroke onset time with presenting severity, early neurological deterioration (END), and long-term functional outcome in human ischemic stroke.
Methods
This nationwide multi-center study included 17,461 consecutive patients with witnessed ischemic stroke within 6 hours of onset. We assessed circadian effects on initial stroke severity (National Institutes of Health Stroke Scale [NIHSS] score at admission), END, and favorable functional outcome (3-month modified Rankin Scale [mRS] score 0-2 versus 3-6).
Results
Mean age was 66.9 (SD 13.4) years, and 6,900 (39.5%) were women. When stroke onset times were grouped by 4-hour intervals, a monotonic gradient in presenting NIHSS score was noted, rising from a nadir in 06:00 to 10:00 to a peak in 02:00 to 06:00. The 18:00 to 22:00 and 22:00 to 02:00 onset stroke patients were more likely to experience END than the 06:00 to 10:00 onset stroke patients. At 3 months, there was a monotonic gradient in the rate of favorable functional outcome, falling from a peak at 06:00 to 10:00 to a nadir at 22:00 to 02:00.
Conclusions
Night-onset stroke, compared with day-onset stroke, is associated with higher presenting neurologic severity, more frequent END, and worse 3-month functional outcome. Therefore, circadian time of onset is an important additional variable for inclusion in epidemiologic natural history studies and in therapeutic trials for acute ischemic stroke.