ABSTRACT NUMBER: ESOC2026A308 ESTIMATED PULSE WAVE VELOCITY PREDICTS OUTCOMES AFTER ACUTE ISCHEMIC STROKE: A MULTINATIONAL COHORT ANALYSIS

Abstract Background and aims Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets. Methods A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2,933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2. Results Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, p<0.001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, p<0.001) and discharge (61.9% vs 29.1%, p<0.001). ePWV independently predicted poor outcome at 90 days (aOR: 1.41, 95% CI: 1.31-1.53) and discharge (aOR: 1.34, 95% CI: 1.27-1.43) after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes (Figure 1). Conclusions ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that independently predicts functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup. Conflict of interest PMB is Stroke Association Professor of Stroke Medicine and an emeritus NIHR Senior Investigator; he has received honoraria from CoMind, DiaMedica and Phagenesis. All authors declare no competing interests directly related to this study. This study was conducted under the auspices of the Hellenic Stroke Organisation Research Network. No external funding was received. Figure 1 - belongs to Results