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Objectives <p>To investigate whether the Atherogenic Index of Plasma (AIP) is independently associated with 90-day functional outcomes in patients with moderate-to-severe acute ischemic stroke (AIS) of presumed atherosclerotic etiology involving the middle cerebral artery (MCA) territory after intravenous thrombolysis (IVT), and to analyze its correlation with infarct core volume.</p> Methods <p>This single-center retrospective cohort study consecutively enrolled AIS patients who underwent IVT within 9&#xa0;h of onset, met CT perfusion (CTP) mismatch criteria (hypoperfusion volume/infarct core volume ratio &gt; 1.2; mismatch volume &gt; 10&#xa0;mL; and infarct core volume &lt; 70&#xa0;mL), and had a baseline NIHSS score ≥ 6 between July 2021 and December 2024. Inclusion required confirmation of an atherosclerotic etiology and restriction of the infarct core to the MCA territory. Fasting lipid profiles were measured within 24&#xa0;h post-thrombolysis to calculate AIP. The primary endpoint was poor functional outcome at 90&#xa0;days (modified Rankin Scale [mRS] score 3–6). Multivariable logistic regression, adjusting for age, onset-to-thrombolysis time (OTT), baseline NIHSS, blood glucose, infarct core volume, mismatch ratio, and intracranial stenosis, was used to analyze the independent association of AIP with the outcome. A restricted cubic spline (RCS) model was employed to assess the dose–response relationship between AIP and the risk of poor outcome. The predictive efficacy of AIP was compared with that of infarct core volume using receiver operating characteristic (ROC) curves.</p> Results <p>A total of 192 patients were included, of whom 65 (33.9%) had poor outcomes. In the fully adjusted multivariable logistic regression model, AIP remained independently associated with poor 90-day functional outcome.&#xa0;Patients in the highest AIP tertile (&gt; 0.28) had a more than tenfold increased risk compared to those in the lowest tertile (&lt; 0.13) (odds ratio [OR] = 10.690, 95% CI 2.316–49.336, <i>P</i> = 0.002), with a significant dose–response relationship (<i>P</i> for trend = 0.009). The association was more pronounced within the standard thrombolysis time window (≤ 4.5&#xa0;h)&#xa0;(OR = 13.79, 95% CI 1.85–102.64, <i>P</i> = 0.010). AIP was significantly positively correlated with infarct core volume (<i>r</i> = 0.347, <i>P</i> &lt; 0.001). ROC analysis indicated that the area under the curve (AUC) for AIP was 0.76 (95% CI 0.69–0.83), with an optimal cutoff value of 0.29. This was not statistically different from the AUC for infarct core volume (0.83, 95% CI 0.76–0.89; <i>P</i> = 0.13). At their optimal cutoff points, AIP demonstrated higher sensitivity (82.6% vs. 69.6%), while infarct core volume exhibited higher specificity (85.7% vs. 71.4%).</p> Conclusions <p>In patients with moderate-to-severe atherosclerotic MCA stroke receiving IVT, elevated AIP measured early post-thrombolysis is independently associated with poor 90-day functional outcome, with a clear dose–response relationship.&#xa0;Patients in the highest AIP tertile (&gt; 0.28) had a more than tenfold increased risk of poor outcome.&#xa0;The predictive value of AIP is particularly evident within the standard time window (≤ 4.5&#xa0;h). Although AIP is positively correlated with infarct core volume, it provides complementary prognostic information—offering high sensitivity suitable for early risk stratification. These findings, derived from a hypothesis-generating study, suggest that AIP may contribute to risk stratification, particularly in resource-limited settings or as part of a multimodal prediction panel. Prospective multicenter studies are warranted for further validation.</p>

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Prognostic value of the Atherogenic Index of Plasma (AIP) after intravenous thrombolysis in moderate-to-severe atherosclerotic middle cerebral artery stroke

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  • 发表日期：

    2026年5月5日

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  • Xianfeng Hou,
  • Xun Mo,
  • Kaibin Qin,
  • Shan Wu,
  • Ping Sun

摘要

Objectives

To investigate whether the Atherogenic Index of Plasma (AIP) is independently associated with 90-day functional outcomes in patients with moderate-to-severe acute ischemic stroke (AIS) of presumed atherosclerotic etiology involving the middle cerebral artery (MCA) territory after intravenous thrombolysis (IVT), and to analyze its correlation with infarct core volume.

Methods

This single-center retrospective cohort study consecutively enrolled AIS patients who underwent IVT within 9 h of onset, met CT perfusion (CTP) mismatch criteria (hypoperfusion volume/infarct core volume ratio > 1.2; mismatch volume > 10 mL; and infarct core volume < 70 mL), and had a baseline NIHSS score ≥ 6 between July 2021 and December 2024. Inclusion required confirmation of an atherosclerotic etiology and restriction of the infarct core to the MCA territory. Fasting lipid profiles were measured within 24 h post-thrombolysis to calculate AIP. The primary endpoint was poor functional outcome at 90 days (modified Rankin Scale [mRS] score 3–6). Multivariable logistic regression, adjusting for age, onset-to-thrombolysis time (OTT), baseline NIHSS, blood glucose, infarct core volume, mismatch ratio, and intracranial stenosis, was used to analyze the independent association of AIP with the outcome. A restricted cubic spline (RCS) model was employed to assess the dose–response relationship between AIP and the risk of poor outcome. The predictive efficacy of AIP was compared with that of infarct core volume using receiver operating characteristic (ROC) curves.

Results

A total of 192 patients were included, of whom 65 (33.9%) had poor outcomes. In the fully adjusted multivariable logistic regression model, AIP remained independently associated with poor 90-day functional outcome. Patients in the highest AIP tertile (> 0.28) had a more than tenfold increased risk compared to those in the lowest tertile (< 0.13) (odds ratio [OR] = 10.690, 95% CI 2.316–49.336, P = 0.002), with a significant dose–response relationship (P for trend = 0.009). The association was more pronounced within the standard thrombolysis time window (≤ 4.5 h) (OR = 13.79, 95% CI 1.85–102.64, P = 0.010). AIP was significantly positively correlated with infarct core volume (r = 0.347, P < 0.001). ROC analysis indicated that the area under the curve (AUC) for AIP was 0.76 (95% CI 0.69–0.83), with an optimal cutoff value of 0.29. This was not statistically different from the AUC for infarct core volume (0.83, 95% CI 0.76–0.89; P = 0.13). At their optimal cutoff points, AIP demonstrated higher sensitivity (82.6% vs. 69.6%), while infarct core volume exhibited higher specificity (85.7% vs. 71.4%).

Conclusions

In patients with moderate-to-severe atherosclerotic MCA stroke receiving IVT, elevated AIP measured early post-thrombolysis is independently associated with poor 90-day functional outcome, with a clear dose–response relationship. Patients in the highest AIP tertile (> 0.28) had a more than tenfold increased risk of poor outcome. The predictive value of AIP is particularly evident within the standard time window (≤ 4.5 h). Although AIP is positively correlated with infarct core volume, it provides complementary prognostic information—offering high sensitivity suitable for early risk stratification. These findings, derived from a hypothesis-generating study, suggest that AIP may contribute to risk stratification, particularly in resource-limited settings or as part of a multimodal prediction panel. Prospective multicenter studies are warranted for further validation.