Background and Objectives: Multiple comorbidities have negative impact on functional outcomes in cardiovascular diseases including ischemic stroke. However, their individual association with acute ischemic stroke(AIS) or transient ischemic attack(TIA) remains to be elucidated. This study aims to evaluate the impact of comorbidity on functional outcome in patients with AIS or TIA.

Methods: A total of 2,449 AIS and 248 TIA patients were included for the analysis. Functional outcome was dichotomized into excellent outcome (modified Rankin scale[mRS] at 3 months 0, 1) and non-excellent outcome (mRS≥2). Logistic regression analysis between comorbidity conditions and outcomes was performed. 

Results: The mean age was 67.1, and 60.3% were male. Among the patients, 44.0% in AIS patients and 12.9% in TIA patients had non-excellent outcome. In patients with AIS, diabetes mellitus (adjusted odds ratio[aOR] 1.23, p=0.025), previous history of stroke (aOR 1.52, p<0.001), dementia (aOR 3.39, p<0.001), moderate to severe kidney disease (aOR 2.52, p<0.001), solid (aOR 1.85, p<0.001) and metastatic tumor (aOR 6.45, p<0.001) were predictors of non-excellent outcome after adjustment. In patients with TIA, congestive heart failure (OR 14.33, p=0.032) were associated with non-excellent outcome in the univariate analysis, but not in the multivariate analysis. The Charlson Comorbidity Index score was significantly associated with non-excellent outcome in AIS group (aOR 1.29, p<0.001), but not in TIA group (aOR 0.93, p=0.692).

Conclusions:  This study demonstrated that multiple comorbidity has a significant impact on functional outcome in patient with AIS, but not in TIA. This suggests that treatment of comorbid conditions is important as well as the index stroke itself.

The adverse effect of multiple comorbidity on functional outcome in patients with ischemic stroke or transient ischemic attack