Abstract Number: Esoc2026a885 Interleukin-1b as a Key Mediator of Recurrent Vascular Events After Acute Ischemic Stroke: Results From the European Crescendo Consortium

Abstract Background and aims Systemic inflammation is an emerging target for secondary stroke prevention. As part of the European “CiRculating mEdiators of Stroke reCurrENce anD aetiOlogies” (CRESCENDO)-consortium, we investigated the role of the interleukin (IL)-1β-IL-6-c-reactive-protein (CRP)-axis for major adverse cardiovascular events (MACE) after acute ischemic stroke (AIS). Methods Serum samples from 4,390 patients were collected in Hannover (Germany), Barcelona/Seville (Spain) and Zurich/Basel (Switzerland) within 24 hours of AIS-onset. Associations of IL-1β, IL-6 and CRP with MACE (defined as recurrent AIS, myocardial infarction or TIA) and recurrent AIS were investigated using regression models adjusting for vascular risk factors, age, sex and the NIHSS-Score. We further stratified these analyses for stroke etiologies and previous anticoagulation status. Results At 90 days of follow-up, 119 patients suffered MACE, and 91 had another AIS. IL-1β was associated both with MACE and AIS (adjusted odds ratio (aOR)=1.38, 95%CI: 1.09-1.73 and aOR=1.34, 95%CI: 1.03-1.75). In contrast, no associations were found for IL-6 and CRP. The etiology-stratified analyses did not reveal substantial differences. Effect sizes of IL-1β for MACE were considerably higher in patients with previous anticoagulation (aOR=1.46, 95%CI: 1.00-2.14) versus without (aOR=1.16, 95%CI: 0.84-1.60). Conclusions The results of this large-scale collaboration reveal that early IL-1β, as an upstream mediator, is likely to play a particularly important role for recurrences across stroke etiologies. These effects were especially pronounced in cases with previous anticoagulation, pointing to inflammation as a key contributor to residual vascular risk in this population. Conflict of interest Nothing to disclose