Abstract 3320: There Is No Difference in Outcomes of Wake-Up Stroke vs. Stoke While Awake. An Analysis from The International Stroke Trial: A Large Prospective Randomized Trial

Abstract

Background: Most acute stroke treatments have restricted therapeutic windows. Approximately a quarter of stroke patients awaken from sleep with symptoms and are precluded from intervention due to extensive times from last known well state. A single center retrospective study showed worse stroke severity and early functional outcomes after wake-up stroke (WUS) compared with stroke while awake (SWA). A population based study has shown demographic and clinical differences between WUS and SWA. Objective: The primary aim of our study was to confirm or refute the findings from the previous studies that WUS has worse outcomes. We also compared the demographic and clinical characteristics and inpatient complications between the two groups. Methods: Data from the International Stroke Trial were analyzed. Comparisons were made between WUS and SWA using χ 2 , student t-test, and Mann-Whitney-Wilcoxon rank sum analyses. Logistic regression analyses were performed to calculate independent effect of WUS in predicting various clinical outcomes. Results: After excluding cases with final diagnosis other than ischemic stroke, 5,152 (29.6%) patients with WUS and 12,246 (70.4%) patients with SWA were included in the analysis. There were no significant differences in age, gender or stroke severity scale between the two groups ( Table 1 ). Atrial fibrillation was significantly less common (15.7% vs. 17.8%) and rate of lacunar stroke was higher (27.5% vs. 22.9%) in the WUS group. WUS patients had a lower unadjusted mortality at six months (20.4% vs. 22.2%, p=0.01). We found no differences in adjusted odds of inpatient mortality (OR 0.97; 95%CI:0.81-1.16), complete recovery (OR: 0.93; 95%CI:0.84-1.03), functional independence (OR:1.02; 95%CI:0.93-1.12) and mortality at six months (OR: 0.95; 95%CI:0.84-1.07) between WUS and SWA. The discharge disposition and the rates of recurrent ischemic stroke, intracranial hemorrhage, hemorrhagic transformation of ischemic stroke and major non-cerebral bleeding were also similar ( p >0.05). Conclusions: Clinical severity and rates of inpatient complications are similar between WUS and SWA. Even though mortality at six months is lower with WUS, the effect is non-significant when controlled for confounding factors. Outcomes at six months are similar between the two groups.