Welcome to the WSC 2022 Interactive Program
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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”
MULTIMORBIDITY IN STROKE IN SPRINT INDIA TRIAL
Abstract
Background and Aims
Stroke multimorbidity is an emerging challenge. There is limited data about multimorbidity in stroke in India. Primary objective is to assess prevalence and association between stroke multimorbidity and all-cause mortality in India.
Methods
Study used data from 30 centres in SPRINT India Trial. Trial was stopped for futility. Patients aged 18 years and above, having first-ever imaging confirmed stroke were included. Multimorbidity is defined as presence of two or more chronic health conditions with stroke. Thirteen chronic health conditions were studied. Primary outcome was prevalence of stroke multimorbidity. Secondary outcomes include type of stroke, sociodemographic and behavioural factors and polypharmacy with stoke multimorbidity. Diseases were clustered by frequency, composition and number to establish patterns of multimorbidity. Chi-square test was used to find association of factors with multimorbidity.
Results
From April 2018 to November 2021, 3038 patients completed a 1-year follow-up, age 55±12.6 years (mean±SD); 2205 (73%) were men. Prevalence of multimorbidity was 1551 (51%). Multimorbidity with ≥3 comorbidities is higher in patients who are older ≥40 years 605 (95%) p<0.001, with polypharmacy 620 (97.5%) p<0.001, have high BMI 26.5±4.8 p<0.001, and from urban region 384 (64%) p<0.001. Vascular events at 1 year were significantly more in patients with ≥3 comorbidities 28 (4.4%) p= 0.038. There was no difference in death and functional outcome at one year.
Conclusions
Multimorbidity was associated with age and polypharmacy. There was increased recurrent stroke, death and cardiac events in patients with more comorbidities. India needs to redesign health system for complex conditions to effectively manage stroke multimorbidity.
MODERATE-INTENSITY ROSUVASTATIN PLUS EZETIMIBE VERSUS HIGH-INTENSITY ROSUVASTATIN FOR LDL-C REDUCTION IN RECENT ISCHEMIC STROKE; A RANDOMIZED CONTROLLED TRIAL (ROSETTA-STROKE)
Abstract
Background and Aims
Ezetimibe added to moderate-intensity rosuvastatin versus high-intensity rosuvastatin alone may provide a greater LDL-C reduction in patients with recent ischemic stroke.
Methods
This randomized, open-label, controlled trial assigned patients with recent ischemic stroke <90 days to rosuvastatin 10 mg plus ezetimibe 10 mg once daily (ROS/EZT 10/10) or to rosuvastatin 20 mg once daily (ROS 20). Key inclusion criteria were statin therapy indicated by guidelines and no pre-stroke statin use. The primary endpoint was the rate of LDL-C reduction >50% at 3 months. Key secondary endpoints were the rate of achieving LDL-C <70 mg/dL, the absolute LDL-C level change, and composite of major vascular events.
Results
Of 584 randomized, 530 were included in the modified intention-to-treat analysis. The baseline LDL-C level was 130.2±34.7 mg/dL in the ROS/EZT-10/10 group and 132.2±39.6 mg/dL and in the ROS-20 group. The ROS/EZT-10/10 group versus the ROS-20 group had a greater rate of LDL-C reduction >50% (72.5% vs 58.0%, p=0.0004). The rate of achieving LDL-C <70 mg/dL (80.2% vs 65.4%, p<0.0001) and the absolute LDL-C level reduction (72.7±37.0 mg/dL vs 65.9±40.1 mg/dL, p=0.0080) were greater in the ROS/EZT-10/10 group than in the ROS-20 group. The composite events occurred in 1 patient the ROS/EZT-10/10 group and 9 in the ROS-20 group (p=0.0080). The adverse event rates did not differ between the two groups.
Conclusions
Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin in LDL-C reduction, achieving LDL-C reduction >50% in more than 70% and LDL-C <70 mg/dL in 80% of patients. (Funded by Hanmi Pharm; ClinicalTrials.gov: NCT03993236)
LATE ANTICOAGULATION IS ASSOCIATED WITH INCREASED NUMBER OF ISCHEMIC LESIONS IN ATRIAL FIBRILLATION RELATED STROKE: THE ATTUNE TRIAL
Abstract
Background and Aims
The optimal time to commence anticoagulation in patients with atrial fibrillation (AF) after ischemic stroke is unclear. Early anticoagulation potentially decreases recurrent ischemic events but is offset by increased risk of hemorrhagic transformation. We aimed to quantify new ischemic lesions and hemorrhages on repeat MRI at 30 days in stroke patients with AF commenced on early versus late anticoagulation. We hypothesized that late anticoagulation was associated with increased new ischemic lesions.
Methods
This was a prospective multicentre study. Inclusion criteria were acute ischemic stroke within 14 days and AF. Anticoagulation timing was categorized as early (<4 days) or late (>/=4 days). MRI brain was obtained at baseline and day 30. The primary outcome was new ischemic lesions on follow up MRI. Multivariate regression analysis was used to analyse the association between anticoagulation timing and new infarcts.
Results
Two hundred and eight patients were included. Median age was 75 (IQR 68 -82), median baseline NIHSS was 5 (IQR 1-11.5) and 40% were female. There were 107 patients in the early and 101 in the late anticoagulation group. Late anticoagulation was associated with increased new infarcts (OR 1.57, 95% CI 1.01- 2.43, p=0.04).
Conclusions
Late anticoagulation (>4 days) is associated with increased ischemic lesions on MRI at follow up. Anticoagulation should not be delayed in patients with AF after ischemic stroke.
EFFECT OF TIME TO INTRAVENOUS THROMBOLYSIS ON CLINICAL OUTCOMES WITH TENECTEPLASE VS. ALTEPLASE: RESULTS FROM THE ACT PHASE 3 RANDOMIZED CONTROLLED TRIAL
Abstract
Background and Aims
We assessed whether the association of faster time to intravenous thrombolysis on clinical outcomes in patients with acute ischemic stroke differs by whether they receive intravenous tenecteplase (tNK) versus alteplase.
Methods
Data are from patients included in AcT, a pragmatic, registry linked, phase 3 randomized trial comparing tenecteplase with alteplase. Logistic regression was used to assess a) the association of onset to needle time(ONT) and door to needle time(DNT) with outcomes and b) if this association was modified by type of intravenous thrombolytic administered (tNK vs. alteplase), after adjusting for age, sex and baseline stroke severity. Primary outcome was modified Rankin scale 0-1(mRS) at 90 days. Secondary outcomes included ordinal mRS, successful reperfusion (extended Thrombolysis In Cerebral Infarction Scale 2b–3), symptomatic intracranial hemorrhage (sICH) and death.
Results
In 1562 included patients (762 alteplase, 800 tenecteplase), median ONT and DNT were 129 mins (IQR 94-186) and 36 mins (IQR 28-49), respectively. No evidence of treatment effect modification by time, either ONT or DNT on the primary clinical outcome (pinteraction for ONT 0.24, DNT 0.70 respectively) was observed. This was also true for all secondary outcomes. Every 30-min delay in ONT and every 5-min delay in DNT was associated with a 9% and 3% decrease in the odds of achieving 90-day mRS 0-1 (adjOR 0.91, 95% CI 0.86-0.96 and adjOR 0.97,95%CI 0.93-1.01 )respectively.
Conclusions
Just as with intravenous alteplase, faster treatment leads to better clinical outcomes when patients with acute ischemic stroke are administered intravenous tenecteplase.