Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score

Introduction: Assessing vascular aging to identify and categorize the residual risk of adverse outcomes in acute ischemic stroke (AIS) is important for improving AIS prognoses. This study aimed to investigate the prognostic value and correlation among three indirect measures of vascular aging derived from 24-hour blood pressure monitoring (24 h-BPM) following AIS. Furthermore, it aimed to develop a new score that includes vascular aging metrics to enhance the prognostic accuracy for stroke outcomes. Methods: A total of 2,730 AIS patients with a mean age of 72.0 ± 14.4 years who underwent 24 h-BPM were included. Three vascular aging indexes derived from 24 h-BPM: estimated pulse wave velocity (ePWV), early vascular aging ambulatory score (EVAAs), and 24-hour pulse pressure (24 h-PP) were evaluated. Primary outcome was the modified Rankin Scale (mRS) score > 2 at 3 months post-stroke. Result: ePWV showed superior predictive value for poor functional outcome (AUC: 0.77, 95% CI: 0.74–0.79) at 3 months post-stroke. Optimal cutoff points for predicting poor functional outcome at 3 months were 12.2 m/s for ePWV (sensitivity: 79.4%, specificity: 61.7%), 65% for EVAAs (sensitivity: 66.4%, specificity: 51.5%), and 51.1mmHg for 24 h-PP (sensitivity: 66.7%, specificity: 46.6%). A new “Severity and Arterial Stiffness” (SASt) score was formulated: SASt = NIHSS + 2*ePWV, which demonstrated excellent discriminatory power for predicting poor functional outcome (AUC: 0.87, 95% CI: 0.85–0.88) at 3 months post-stroke. Conclusions: The ePWV and the new SASt score show promising potential as tools for identifying patients at higher risk for poor outcomes at 3 months post-stroke. While these findings are encouraging, further prospective studies are needed to validate their utility before they can be adopted in clinical practice.