ABSTRACT NUMBER: ESOC2026A2097 INTERCONTINENTAL DIFFERENCES IN COMPLICATIONS AND OUTCOMES IN SEVERE INTRACEREBRAL HEMORRHAGE

Abstract Background and aims We aimed to compare regional differences in patient characteristics, hospital care and their impact on outcomes after severe intracerebral hemorrhage (ICH) in Europe versus North America (NA). Methods Patients enrolled in the CLEAR-III and MISTIE-III clinical trials were dichotomized by hospital location into NA and Europe groups. Primary outcome was 1-year mRS; secondary outcome was EQVAS. Multivariable regression evaluated associations between continent and 1-year outcomes. Mediation analyses assessed contributors to EQVAS differences. Results Among 779 patients from NA and 202 from Europe, European patients were older with more atrial fibrillation and anticoagulation, while NA had more Black patients, hypertension, CAD, and antiplatelet use. ICH severity, minimally invasive surgical interventions and end-of-treatment hematoma volumes did not differ, but cardiac adverse events, CNS infections were more common in Europe, and UTI and ischemic strokes in NA. Supportive interventions (except tracheostomy) were more common in NA, but ICU length of stay was longer in Europe. One-year mRS scores did not differ (4[3–5] vs. 4[3–6];p=0.07), but withdrawal-of-care was higher in NA (13%.vs.8%;p=0.04). In adjusted models, continent was independently associated with EQVAS (Europe.vs.NA, beta:-4.5, 95%CI [-8.9– -0.1];p=0.045), but not with mRS. Higher age and longer ICU stay partially mediated the continent–EQVAS relationship. Conclusions Demographics, co-morbidities and hospital complications differed significantly among severe ICH patients treated in NA and Europe. While this did not impact functional outcome, health-related quality of life was worse in Europe, partly mediated by longer ICU stays and older age. Conflict of interest Vishank Shah: nothing to disclose; Katja Wartenberg: nothing to disclose; Meghana Rao: nothing to disclose; Issam Awad: supported by NIH grants; Daniel F Hanley: supported by NIH grants; Wendy Ziai: supported by NIH grants