Abstract Body: Introduction: The link between arterial stiffness, measured by estimated pulse wave velocity (ePWV), and outcomes following endovascular treatment (EVT) is unclear.
Hypothesis: This study aimed to determine whether ePWV predicts post-EVT outcome in patients with acute ischemic stroke.
Methods: This study was a secondary analysis of the OPTIMAL-BP trial, which enrolled 302 EVT patients from 19 stroke centers in Korea between June 18, 2020 and November 28, 2022. The ePWV was calculated using a regression equation based on age and mean blood pressure at trial enrollment. The primary outcome was functional independence at 3 months, defined as a modified Rankin Scale (mRS) score of 0-2. Logistic, ordinal, or linear regression analyses were employed to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for outcomes per 1 m/s or quartile ePWV increase.
Results: Among 302 patients (mean age 73.1±11.5 years, 59.6% male), higher ePWV was independently associated with a lower likelihood of functional independence at 3 months (OR 0.799, 95% CI 0.676–0.944 per 1 m/s increase; OR 0.358, 95% CI 0.135–0.947 for the fourth quartile), higher mRS scores (OR 1.220, 95% CI 1.071–1.390 per 1 m/s increase; OR 2.406, 95% CI 1.102–5.254 for the fourth quartile), and lower EQ-5D-3L scores (OR -0.057, 95% CI -0.084 to -0.030 per 1 m/s increase). Incorporating ePWV significantly improved prognostic model performance, with net reclassification improvement (NRI) of 0.279 (95% CI 0.056–0.503) and integrated discrimination improvement (IDI) of 0.019 (95% CI 0.003–0.036) per 1 m/s increase, and NRI of 0.270 (95% CI 0.070–0.470) and IDI of 0.014 (95% CI 0.001–0.027) per quartile increase, respectively.
Conclusions: ePWV independently predicts functional independence after EVT, suggesting its potential as a practical prognostic tool using age and baseline blood pressure.