Activity measure post-acute care score for discharge outcomes is associated with prolonged venous transit on perfusion imaging in reperfused large vessel occlusion strokes

Background: Activity Measure for Post-Acute Care (AM-PAC) score is used in discharge planning for patients with acute ischemic stroke from a large vessel occlusion (AIS-LVO). Prolonged venous transit (PVT) is a binary, qualitative measure visually ascertained from computed tomography perfusion imaging time-to-maximum (Tmax) maps. PVT has been associated with unfavorable recovery and mortality. Objective: To assess the robustness of PVT by evaluating its association with AM-PAC. Methods: Consecutive adult patients with AIS-LVO treated successfully with reperfusion therapy were retrospectively reviewed. PVT+ is defined as Tmax (Formula presented.) 10 seconds timing on at least one of the following: superior sagittal sinus and/or torcula. PVT− lacks this in both regions. Primary outcome was favorable AM-PAC score, defined as having both Basic Mobility Score (Formula presented.) 17 and Daily Activity Score (Formula presented.) 19. Logistic regressions in unmatched and 1:1 propensity score-matched cohorts were performed. Results: Among 121 patients, the median age was 72 (interquartile range, 64–81) years. Favorable AM-PAC scores occurred less often in PVT+ than PVT− patients (10.5% vs. 45.8%). PVT+ was associated with significantly reduced odds of favorable AM-PAC score in multivariable regressions (PVT+ vs. PVT− odds ratio [OR]: 0.11, 95% confidence interval [CI]: 0.03–0.48, p =.01); the significant association furthermore persisted in the matched cohort analysis (PVT+ vs. PVT− OR: 0.73, 95% CI: 0.60–0.88, p <.001). Conclusion: PVT+ is independently associated with lower odds of favorable AM-PAC scores at discharge. Logistically-consistent associations with short-term and long-term clinical outcomes augment our understanding of PVT and further establish the potential of this novel imaging parameter as an informative metric in clinical practice.