轻度缺血性脑卒中症状患者结局的预测因素：MaRISS。
Predictors of Outcomes in Patients With Mild Ischemic Stroke Symptoms: MaRISS.
机构信息
Department of Neurology, University of Miami Miller School of Medicine, FL (J.G.R., H.G., I.C.-B., R.L.S.).
American Heart Association, Dallas, TX (Y.K., S.T., N.R., H.M.A.).
出版信息
Stroke. 2021 Jun;52(6):1995-2004. doi: 10.1161/STROKEAHA.120.032809. Epub 2021 May 5.
BACKGROUND AND PURPOSE
Although most strokes present with mild symptoms, these have been poorly represented in clinical trials. The objective of this study is to describe multidimensional outcomes, identify predictors of worse outcomes, and explore the effect of thrombolysis in this population.
METHODS
This prospective observational study included patients with ischemic stroke or transient ischemic attack, a baseline National Institutes of Health Stroke Scale (NIHSS) score 0 to 5, presenting within 4.5 hours from symptom onset. The primary outcome was a 90-day modified Rankin Scale score of 0 to 1; secondary outcomes included good outcomes in the Barthel Index, Stroke Impact Scale-16, and European Quality of Life. Multivariable models were created to determine predictors of outcomes and the effect of alteplase.
RESULTS
A total of 1765 participants were included from 100 Get With The Guidelines-Stroke participating hospitals (age, 65±14; 42% women; final diagnosis of ischemic stroke, 90%; transient ischemic attack, 10%; 57% received alteplase). At 90 days, 37% were disabled and 25% not independent. Worse outcomes were noted for older individuals, women, non-Hispanic Blacks and Hispanics, Medicaid recipients, smokers, those with diabetes, atrial fibrillation, prior stroke, higher baseline NIHSS, visual field defects, and extremity weakness. Similar outcomes were noted for the alteplase-treated and untreated groups. Alteplase-treated patients were younger (64±13 versus 67±1.4) with higher NIHSS (2.9±1.4 versus 1.7±1.4). After adjusting for age, sex, race/ethnicity, and baseline NIHSS, we did not identify an effect of alteplase on the primary outcome but did find an association with Stroke Impact Scale-16 in the restricted sample of baseline NIHSS score 3–5. Few symptomatic intracerebral hemorrhages were recorded (<1%).
CONCLUSIONS
A large proportion of stroke patients presenting with low NIHSS have a disabled outcome. Baseline predictors of worse outcomes are described. An effect of alteplase on outcomes was not identified in the overall cohort, but a suggestion of efficacy was noted in the NIHSS 3–5 subgroup.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02072681.
背景与目的
尽管大多数中风患者的症状较轻，但这些在临床试验中并未得到充分体现。本研究的目的是描述多维结局，确定预后不良的预测因素，并探讨该人群中溶栓的效果。
方法
这是一项前瞻性观察性研究，纳入发病 4.5 小时内的 NIHSS 基线评分 0-5 分的缺血性卒中和短暂性脑缺血发作患者。主要结局为 90 天改良 Rankin 量表评分 0-1 分；次要结局包括 Barthel 指数、中风影响量表-16 和欧洲生活质量量表的良好结局。建立多变量模型以确定结局的预测因素和阿替普酶的效果。
结果
共纳入 100 家 Get With The Guidelines-Stroke 参与医院的 1765 例患者（年龄 65±14 岁；42%为女性；最终诊断为缺血性卒中 90%，短暂性脑缺血发作 10%；57%接受阿替普酶治疗）。90 天时，37%的患者残疾，25%的患者不能独立生活。年龄较大、女性、非西班牙裔黑人和西班牙裔、医疗补助接受者、吸烟者、有糖尿病、心房颤动、既往中风、较高的基线 NIHSS、视野缺损和肢体无力的患者预后较差。阿替普酶治疗组和未治疗组的结局相似。阿替普酶治疗组患者年龄较小（64±13 岁比 67±1.4 岁），基线 NIHSS 评分较高（2.9±1.4 比 1.7±1.4）。在调整年龄、性别、种族和基线 NIHSS 后，我们没有发现阿替普酶对主要结局有影响，但在基线 NIHSS 评分 3-5 的限制样本中发现阿替普酶与中风影响量表-16 之间存在关联。记录到的症状性颅内出血很少（<1%）。
结论
大量 NIHSS 评分较低的中风患者预后不良。描述了预后不良的基线预测因素。在整个队列中未发现阿替普酶对结局的影响，但在 NIHSS 3-5 亚组中提示有效。
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