Association between systolic blood pressure course and outcomes after stroke thrombectomy.
cerebrovascular
clinical neurology
stroke
Journal
BMJ neurology open
ISSN: 2632-6140
Titre abrégé: BMJ Neurol Open
Pays: England
ID NLM: 101775450
Informations de publication
Date de publication:
2021
2021
Historique:
received:
31
05
2021
accepted:
03
11
2021
entrez:
6
12
2021
pubmed:
7
12
2021
medline:
7
12
2021
Statut:
epublish
Résumé
Systolic blood pressure (SBP) after endovascular thrombectomy (EVT) for large artery occlusive stroke is dynamic, requiring adaptable early prediction tools for improving outcomes. We investigated if post-EVT SBP course was associated with outcomes. EVT-treated patients who had a stroke at Karolinska University Hospital, Stockholm, Sweden, were included in the study during 12 February 2018-11 February 2020. SBP was recorded during the first 24 hours after EVT. Primary outcome was functional independence defined by a Modified Rankin Scale score of 0-2 at 3 months. Secondary outcomes were death by 3 months, symptomatic intracranial haemorrhage and any intracranial haemorrhage. Patients with favourable outcomes were used as a reference SBP course in mixed linear effects models and compared with SBP courses of patients with unfavourable outcomes using the empirical best linear unbiased predictor, measuring deviations from the reference SBP course using the random effects. We tested model predictive stability for SBP measurements of only 18, 12 or 6 hours after EVT. 374 patients were registered, with mean age 71, median NIHSS score of 15, and 53.2% men. Deviating from a linear SBP course starting at 130 mm Hg and decreasing to 123 mm Hg at 24 hours after EVT was associated with lower chances of functional independence (adjusted OR 0.53, 95% CI 0.29 to 0.88, for reaching either 99 or 147 mm Hg at 24 hours after EVT). All SBP course models for the remaining outcomes did not show statistical significance. Functional independence models showed stable predictive values for all time periods. Deviating from a linear SBP course was associated with lower chances of 3-month functional independence.
Sections du résumé
BACKGROUND
BACKGROUND
Systolic blood pressure (SBP) after endovascular thrombectomy (EVT) for large artery occlusive stroke is dynamic, requiring adaptable early prediction tools for improving outcomes. We investigated if post-EVT SBP course was associated with outcomes.
METHODS
METHODS
EVT-treated patients who had a stroke at Karolinska University Hospital, Stockholm, Sweden, were included in the study during 12 February 2018-11 February 2020. SBP was recorded during the first 24 hours after EVT. Primary outcome was functional independence defined by a Modified Rankin Scale score of 0-2 at 3 months. Secondary outcomes were death by 3 months, symptomatic intracranial haemorrhage and any intracranial haemorrhage. Patients with favourable outcomes were used as a reference SBP course in mixed linear effects models and compared with SBP courses of patients with unfavourable outcomes using the empirical best linear unbiased predictor, measuring deviations from the reference SBP course using the random effects. We tested model predictive stability for SBP measurements of only 18, 12 or 6 hours after EVT.
RESULTS
RESULTS
374 patients were registered, with mean age 71, median NIHSS score of 15, and 53.2% men. Deviating from a linear SBP course starting at 130 mm Hg and decreasing to 123 mm Hg at 24 hours after EVT was associated with lower chances of functional independence (adjusted OR 0.53, 95% CI 0.29 to 0.88, for reaching either 99 or 147 mm Hg at 24 hours after EVT). All SBP course models for the remaining outcomes did not show statistical significance. Functional independence models showed stable predictive values for all time periods.
CONCLUSION
CONCLUSIONS
Deviating from a linear SBP course was associated with lower chances of 3-month functional independence.
Identifiants
pubmed: 34870205
doi: 10.1136/bmjno-2021-000183
pii: bmjno-2021-000183
pmc: PMC8603273
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000183Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Stroke. 2020 Feb;51(2):511-518
pubmed: 31813361
Stroke. 2019 Dec;50(12):3449-3455
pubmed: 31587660
Hypertension. 2020 Mar;75(3):730-739
pubmed: 31928111
Stroke. 2017 Jul;48(7):1869-1876
pubmed: 28432266
Stroke. 2020 Mar;51(3):914-921
pubmed: 32078493
Neurology. 2017 Aug 8;89(6):540-547
pubmed: 28687721
J Neurointerv Surg. 2018 Oct;10(10):925-931
pubmed: 29326379
Eur J Neurol. 2019 Jul;26(7):1019-1027
pubmed: 30868681
Lancet Neurol. 2021 Apr;20(4):265-274
pubmed: 33647246
Ann Neurol. 2020 Jun;87(6):830-839
pubmed: 32187711
Stroke. 2020 Feb;51(2):519-525
pubmed: 31822252
Stroke. 2018 Mar;49(3):e46-e110
pubmed: 29367334
Eur J Neurol. 2021 Jun;28(6):1922-1930
pubmed: 33682232
J Multivar Anal. 2010 Apr 1;101(4):882
pubmed: 20161652
Ther Adv Neurol Disord. 2021 Mar 5;14:1756286421997383
pubmed: 33747130
J Clin Neurosci. 2019 Apr;62:94-99
pubmed: 30594447
Stroke. 2005 Feb;36(2):264-8
pubmed: 15637309
Epidemiology. 1999 Jan;10(1):37-48
pubmed: 9888278
Stroke. 2016 Jun;47(6):1571-6
pubmed: 27118796
Sci Rep. 2021 Sep 9;11(1):17973
pubmed: 34504221
Stroke. 2017 Jul;48(7):1717-1719
pubmed: 28536174
J Am Heart Assoc. 2017 May 18;6(5):
pubmed: 28522673
Stroke. 2019 Sep;50(9):2448-2454
pubmed: 31318633
J Neurointerv Surg. 2017 May;9(5):455-458
pubmed: 27084964
Stroke. 2013 Sep;44(9):2650-63
pubmed: 23920012