尽管实现了再通但预后不良的预测因素：对美国国家航空航天局注册数据库的多元回归分析
Predictors of poor outcome despite recanalization: a multiple regression analysis of the NASA registry.
作者信息
Linfante Italo, Starosciak Amy K, Walker Gail R, Dabus Guilherme, Castonguay Alicia C, Gupta Rishi, Sun Chung-Huan J, Martin Coleman, Holloway William E, Mueller-Kronast Nils, English Joey D, Malisch Tim W, Marden Franklin A, Bozorgchami Hormozd, Xavier Andrew, Rai Ansaar T, Froehler Michael T, Badruddin Aamir, Nguyen Thanh N, Taqi M Asif, Abraham Michael G, Janardhan Vallabh, Shaltoni Hashem, Novakovic Roberta, Yoo Albert J, Abou-Chebl Alex, Chen Peng R, Britz Gavin W, Kaushal Ritesh, Nanda Ashish, Issa Mohammad A, Nogueira Raul G, Zaidat Osama O
机构信息
Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA Neuroscience Center, Baptist Hospital, Miami, Florida, USA.
Neuroscience Center, Baptist Hospital, Miami, Florida, USA Center for Research and Grants, Baptist Health South Florida, Coral Gables, Florida, USA.
出版信息
J Neurointerv Surg. 2016 Mar;8(3):224-9. doi: 10.1136/neurintsurg-2014-011525. Epub 2015 Jan 6.
BACKGROUND
Mechanical thrombectomy with stent-retrievers results in higher recanalization rates compared with previous devices. Despite successful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b) of 70-83%, good outcomes by 90-day modified Rankin Scale (mRS) score ≤2 are achieved in only 40-55% of patients. We evaluated predictors of poor outcomes (mRS >2) despite successful recanalization (TICI ≥2b) in the North American Solitaire Stent Retriever Acute Stroke (NASA) registry.
METHODS
Logistic regression was used to evaluate baseline characteristics and recanalization outcomes for association with 90-day mRS score of 0-2 (good outcome) vs 3-6 (poor outcome). Univariate tests were carried out for all factors. A multivariable model was developed based on backwards selection from the factors with at least marginal significance (p≤0.10) on univariate analysis with the retention criterion set at p≤0.05. The model was refit to minimize the number of cases excluded because of missing covariate values; the c-statistic was a measure of predictive power.
RESULTS
Of 354 patients, 256 (72.3%) were recanalized successfully. Based on 234 recanalized patients evaluated for 90-day mRS score, 116 (49.6%) had poor outcomes. Univariate analysis identified an increased risk of poor outcome for age ≥80 years, occlusion site of internal carotid artery (ICA)/basilar artery, National Institute of Health Stroke Scale (NIHSS) score ≥18, history of diabetes mellitus, TICI 2b, use of rescue therapy, not using a balloon-guided catheter or intravenous tissue plasminogen activator (IV t-PA), and >30 min to recanalization (p≤0.05). In multivariable analysis, age ≥80 years, occlusion site ICA/basilar, initial NIHSS score ≥18, diabetes, absence of IV t-PA, ≥3 passes, and use of rescue therapy were significant independent predictors of poor 90-day outcome in a model with good predictive power (c-index=0.80).
CONCLUSIONS
Age, occlusion site, high NIHSS, diabetes, no IV t-PA, ≥3 passes, and use of rescue therapy are associated with poor 90-day outcome despite successful recanalization.
背景
与先前的器械相比，使用支架取栓器进行机械取栓可实现更高的再通率。尽管再通成功率（脑梗死溶栓（TICI）评分≥2b）达到70%-83%，但90天改良Rankin量表（mRS）评分≤2的良好预后仅在40%-55%的患者中实现。我们在北美Solitaire支架取栓器急性卒中（NASA）注册研究中评估了尽管成功再通（TICI≥2b）但预后不良（mRS>2）的预测因素。
方法
采用逻辑回归评估基线特征和再通结果与90天mRS评分为0-2（良好预后）对比3-6（不良预后）之间的相关性。对所有因素进行单变量检验。基于单变量分析中至少具有边际显著性（p≤0.10）的因素进行向后选择建立多变量模型，保留标准设定为p≤0.05。对模型进行重新拟合以尽量减少因协变量值缺失而排除的病例数；c统计量是预测能力的一种度量。
结果
354例患者中，256例（72.3%）成功实现再通。基于对234例再通患者进行90天mRS评分评估，116例（49.6%）预后不良。单变量分析确定年龄≥80岁、颈内动脉（ICA）/基底动脉闭塞部位、美国国立卫生研究院卒中量表（NIHSS）评分≥18、糖尿病史、TICI 2b、使用补救治疗、未使用球囊引导导管或静脉注射组织型纤溶酶原激活剂（IV t-PA）以及再通时间>30分钟与不良预后风险增加相关（p≤0.05）。在多变量分析中，年龄≥80岁、闭塞部位ICA/基底动脉、初始NIHSS评分≥18、糖尿病、未使用IV t-PA、≥3次操作以及使用补救治疗是90天不良预后的显著独立预测因素，该模型具有良好的预测能力（c指数=0.80）。
结论
尽管成功再通，但年龄、闭塞部位、高NIHSS评分、糖尿病、未使用IV t-PA、≥3次操作以及使用补救治疗与90天不良预后相关。
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