Matusevicius Marius, Cooray Charith, Holmin Staffan, Bottai Matteo, Ahmed Niaz
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Research and Education, Karolinska University Hospital, Stockholm, Sweden.
BMJ Neurol Open. 2021 Nov 18;3(2):e000183. doi: 10.1136/bmjno-2021-000183. eCollection 2021.
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.
大动脉闭塞性卒中血管内血栓切除术（EVT）后的收缩压（SBP）是动态变化的，需要适用的早期预测工具来改善预后。我们研究了EVT后SBP变化过程是否与预后相关。
2018年2月12日至2020年2月11日期间，瑞典斯德哥尔摩卡罗林斯卡大学医院接受EVT治疗的卒中患者纳入本研究。在EVT后的头24小时内记录SBP。主要结局是3个月时改良Rankin量表评分为0 - 2定义的功能独立性。次要结局是3个月时的死亡、症状性颅内出血和任何颅内出血。在混合线性效应模型中，将预后良好的患者作为参考SBP变化过程，并使用经验最佳线性无偏预测器与预后不良患者的SBP变化过程进行比较，使用随机效应测量与参考SBP变化过程的偏差。我们测试了仅在EVT后18、12或6小时进行SBP测量时模型的预测稳定性。
登记了374例患者，平均年龄71岁，美国国立卫生研究院卒中量表（NIHSS）中位数评分为15分，男性占53.2%。与从130 mmHg开始并在EVT后24小时降至123 mmHg的线性SBP变化过程出现偏差，与功能独立性的可能性较低相关（在EVT后24小时达到99或147 mmHg时，调整后的比值比为0.53，95%置信区间为0.29至0.88）。其余结局的所有SBP变化过程模型均未显示统计学意义。功能独立性模型在所有时间段均显示出稳定的预测值。
与线性SBP变化过程出现偏差与3个月功能独立性的可能性较低相关。
