Determinants of prognosis after reperfusion therapy in acute ischemic stroke and development of a predictive model.

Introduction: Acute ischemic stroke (AIS) remains a leading cause of death and disability worldwide. Despite improvements in recanalization rates with intravenous thrombolysis and mechanical thrombectomy, a substantial proportion of patients experience poor functional recovery. Conventional endpoints based solely on the 3-month modified Rankin Scale (mRS) may be affected by heterogeneity in baseline functional status. This study used ΔmRS as a directional indicator of functional improvement and developed an admission-based pre-reperfusion model to predict poor functional recovery after reperfusion therapy. Methods: This single-center retrospective cohort study included 374 patients with AIS who underwent reperfusion therapy at Yantai Affiliated Hospital of Binzhou Medical University between October 2023 and December 2024. ΔmRS was calculated as the admission mRS score minus the 3-month mRS score. Patients were classified as having significant functional improvement when ΔmRS was ≥2 and as having non-significant improvement or poor functional recovery when ΔmRS was <2. Patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Predictors were selected using LASSO regression and multivariable logistic regression, and a nomogram was subsequently developed. Results: Poor functional recovery occurred in 124 of 374 patients (33%). Higher admission National Institutes of Health Stroke Scale score, lower baseline Alberta Stroke Program Early CT Score, elevated admission blood glucose level, higher age-adjusted Charlson Comorbidity Index score, and concomitant atrial fibrillation were independently associated with poor functional recovery. The model achieved an area under the receiver operating characteristic curve of 0.832 in the training cohort and 0.799 in the validation cohort, with acceptable calibration and potential net clinical benefit. Discussion: The ΔmRS-based nomogram may provide a preliminary and clinically interpretable tool for early risk stratification in patients with AIS undergoing reperfusion therapy. ΔmRS should be regarded as a complementary rather than replacement outcome measure, and the model requires further validation in larger, multicenter, and external cohorts.