Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China,
Department of Central Laboratory, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Cerebrovasc Dis. 2023;52(2):202-209. doi: 10.1159/000526124. Epub 2022 Oct 11.
Acute ischemic stroke due to basilar artery occlusion (BAO) is associated with the highest mortality in patients with large vessel occlusion. This study aimed to identify modifiable risk factors of early mortality in patients with BAO.
This was a cohort study of consecutive patients with BAO admitted to 47 stroke centers in China between January 2014 and May 2019. The primary outcome was all-cause mortality within 7 days after hospitalization. Of 829 patients, 164 died (0-3 days: 115; 4-7 days: 49) within 7 days after hospitalization. Among pre- and periprocedural variables, higher admission National Institutes of Health Stroke Scale (NIHSS, adjusted OR, 1.06, 95% CI: 1.04-1.09; p < 0.001), lower admission posterior circulation-Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS, adjusted OR, 0.88, 95% CI: 0.79-0.98; p = 0.02), lower Basilar Artery on Computed Tomography Angiography score (BATMAN, adjusted OR, 0.84, 95% CI: 0.76-0.93; p = 0.001), and recanalization failure (adjusted OR, 2.99, 95% CI: 2.04-4.38; p < 0.001) were independently associated with a higher risk of early mortality. Herniation (adjusted OR, 2.84, 95% CI: 1.52-5.30; p = 0.001) is an independent postprocedural predictor of early mortality. In patients dying ≤3 days, higher NIHSS (p < 0.001), lower pc-ASPECTS (p = 0.01), lower BATMAN (p = 0.004), recanalization failure (p < 0.001), herniation (p = 0.001), gastrointestinal hemorrhage (p = 0.046), and absence of pneumonia (p < 0.001) were independent predictors of early mortality. Higher NIHSS (p = 0.01), recanalization failure (p < 0.001), and pneumonia (p = 0.03) were independently associated with early mortality between 4 and 7 days.
Recanalization failure, herniation, gastrointestinal hemorrhage, and pneumonia are potentially modifiable risk factors for early mortality in basilar artery occlusion.
基底动脉闭塞（BAO）引起的急性缺血性脑卒中与大血管闭塞患者的死亡率最高有关。本研究旨在确定 BAO 患者早期死亡的可改变的危险因素。
这是一项连续纳入 2014 年 1 月至 2019 年 5 月期间在中国 47 个卒中中心的 BAO 患者的队列研究。主要结局为住院后 7 天内的全因死亡率。829 例患者中，164 例（0-3 天：115 例；4-7 天：49 例）在住院后 7 天内死亡。在术前和围手术期变量中，较高的入院国立卫生研究院卒中量表（NIHSS，调整后的比值比，1.06，95%可信区间：1.04-1.09；p<0.001）、较低的入院后循环-阿尔伯塔卒中项目早期计算机断层扫描评分（pc-ASPECTS，调整后的比值比，0.88，95%可信区间：0.79-0.98；p=0.02）、较低的基底动脉计算机断层血管造影评分（BATMAN，调整后的比值比，0.84，95%可信区间：0.76-0.93；p=0.001）和再通失败（调整后的比值比，2.99，95%可信区间：2.04-4.38；p<0.001）与早期死亡率的风险增加独立相关。脑疝（调整后的比值比，2.84，95%可信区间：1.52-5.30；p=0.001）是术后早期死亡的独立预测因素。在≤3 天死亡的患者中，较高的 NIHSS（p<0.001）、较低的 pc-ASPECTS（p=0.01）、较低的 BATMAN（p=0.004）、再通失败（p<0.001）、脑疝（p=0.001）、胃肠道出血（p=0.046）和无肺炎（p<0.001）是早期死亡率的独立预测因素。较高的 NIHSS（p=0.01）、再通失败（p<0.001）和肺炎（p=0.03）与 4-7 天内的早期死亡率独立相关。
再通失败、脑疝、胃肠道出血和肺炎是基底动脉闭塞早期死亡的潜在可改变的危险因素。
