Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Brain Behav. 2023 Jun;13(6):e3022. doi: 10.1002/brb3.3022. Epub 2023 May 22.
This study aimed to investigate the relationship between baseline blood pressure (BP) and clinical outcomes after thrombolysis for acute ischemic stroke (AIS) in different intracranial arterial stenosis subgroups.
AIS patients from multicenter with intravenous thrombolysis were retrospectively enrolled from January 2013 to December 2021. We categorized participants into severe (≥ 70%) and nonsevere (< 70%) stenosis of major intracranial arteries subgroups. The primary outcome was unfavorable functional outcome defined as 3-month modified Rankin Scale (mRS) ≥2. The association coefficients between baseline BP and functional outcomes were estimated in general linear regression model. The interactive effect was tested to determine the influence of intracranial arterial stenosis on the association between BP and clinical outcomes.
A total of 329 patients were included. Severe subgroup was detected in 151 patients with average age of 70.5. Association between baseline diastolic BP (DBP) and unfavorable functional outcome in intracranial artery stenosis subgroups was significantly different (p for interaction < .05). In nonsevere subgroup, higher baseline DBP was associated with higher risk of unfavorable outcome (OR 1.11, 95% CI 1.03 to 1.20, p = .009) compared with severe subgroup (OR 1.02, 95% CI 0.97 to 1.08, p = .341). Besides, intracranial artery stenosis also modified association between baseline systolic BP (SBP) and 3-month death (p for interaction < .05). In severe subgroup, higher baseline SBP was associated with decreased 3-month death risk (OR 0.88, 95% CI 0.78 to 1, p = .044) compared with nonsevere subgroup (OR 1, 95% CI 0.93 to 1.07, p = .908).
The major intracranial artery state modulates association between baseline BP and 3-month clinical outcomes after intravenous thrombolysis.
本研究旨在探讨不同颅内动脉狭窄亚组中急性缺血性脑卒中（AIS）溶栓后基线血压（BP）与临床结局的关系。
本研究回顾性纳入 2013 年 1 月至 2021 年 12 月接受静脉溶栓治疗的多中心 AIS 患者。将患者分为颅内主要动脉重度（≥70%）和非重度狭窄（<70%）亚组。主要结局为 3 个月时改良 Rankin 量表（mRS）评分≥2 的不良功能结局。采用线性回归模型估计基线 BP 与功能结局之间的关联系数。通过交互作用检验来确定颅内动脉狭窄对 BP 与临床结局之间关联的影响。
共纳入 329 例患者，其中重度狭窄亚组 151 例，平均年龄为 70.5 岁。颅内动脉狭窄亚组间基线舒张压（DBP）与不良功能结局的相关性存在显著差异（交互作用 p 值<0.05）。在非重度狭窄亚组中，与重度狭窄亚组相比，较高的基线 DBP 与不良结局的风险增加相关（OR 1.11，95%CI 1.03 至 1.20，p=0.009）。此外，颅内动脉狭窄还改变了基线收缩压（SBP）与 3 个月死亡之间的关联（交互作用 p 值<0.05）。在重度狭窄亚组中，与非重度狭窄亚组相比，较高的基线 SBP 与 3 个月死亡风险降低相关（OR 0.88，95%CI 0.78 至 1，p=0.044）。
颅内主要动脉状态调节了静脉溶栓后基线 BP 与 3 个月临床结局之间的关系。
