Abstract WP326: Pre-Stroke Frailty and Ischemic Stroke Outcomes in Vietnam: Exploring the Role of the Clinical Frailty Scale in Predicting Recovery After EVT

Stroke is a major global health issue, with a particularly high burden in Vietnam. While endovascular treatment (EVT) has revolutionized care for acute ischemic stroke, outcomes vary. This study investigated the Clinical Frailty Scale (CFS) as a predictor of functional outcomes in older Vietnamese patients undergoing EVT. Understanding this relationship is crucial for improving patient selection and resource allocation. Objective: This study aimed to evaluate the predictive value of the CFS in Vietnamese patients with acute ischemic stroke (AIS) undergoing EVT and to determine the score's association with functional outcomes at 1 and 3 months post-intervention. Patients and methods: A prospective cohort study was conducted at the 108 Military Central Hospital in Vietnam from April 2023 to January 2024. The study enrolled consecutive adult patients with acute ischemic stroke (AIS) who underwent endovascular thrombectomy (EVT). Patients were included if they met specific criteria, including an Alberta Stroke Program Early CT Score (ASPECTS) of ≥6, a National Institutes of Health Stroke Scale (NIHSS) score >6, and a premorbid modified Rankin Scale (mRS) score of 0–2. Frailty was assessed retrospectively using the CFS, classifying patients as non-frail (CFS 1–4) or frail (CFS ≥5). Functional outcomes at 3 months were measured by the modified Rankin Scale (mRS). Logistic regression identified independent predictors, and ROC curves evaluated diagnostic accuracy. Results: Median age was 68 years, and 69.6% were male. Frailty prevalence (CFS ≥5) was 8.7%. At 3 months, 70.4% achieved favorable outcomes (mRS 0–2). Frailty was significantly associated with poor outcomes: only 20% of frail patients achieved functional independence versus 76.1% of non-frail (p < 0.001). Multivariable analysis confirmed that age, NIHSS score, and CFS independently predicted outcomes (CFS aOR 0.35, 95% CI 0.19–0.64, p = 0.001). ROC analysis showed strong predictive performance of the CFS (AUC 0.79 for favorable outcomes; 0.84 for excellent outcomes). Conclusion: Pre-stroke frailty, assessed by the Clinical Frailty Scale, is a strong independent predictor of poor functional recovery after EVT in Vietnamese AIS patients. Routine CFS assessment may improve patient selection, guide prognosis discussions, and optimize resource allocation in stroke care. Keywords: Acute ischemic stroke, Endovascular treatment, Clinical Frailty Scale, Functional outcomes, Vietnam