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

Abstract 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 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 17 and Daily Activity Score 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.