Department of Neuroscience, County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania.
Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Int J Stroke. 2023 Dec;18(10):1209-1218. doi: 10.1177/17474930231185471. Epub 2023 Jul 5.
Few data exist on acute stroke treatment in patients with pre-existing disability (PD) since they are usually excluded from clinical trials. A recent trial of mobile stroke units (MSUs) demonstrated faster treatment and improved outcomes, and included PD patients.
To determine outcomes with tissue plasminogen activator (tPA), and benefit of MSU versus management by emergency medical services (EMS), for PD patients.
Primary outcomes were utility-weighted modified Rankin Scale (uw-mRS). Linear and logistic regression models compared outcomes in patients with versus without PD, and PD patients treated by MSU versus standard management by EMS. Time metrics, safety, quality of life, and health-care utilization were compared.
Of the 1047 tPA-eligible ischemic stroke patients, 254 were with PD (baseline mRS 2-5) and 793 were without PD (baseline mRS 0-1). Although PD patients had worse 90-day uw-mRS, higher mortality, more health-care utilization, and worse quality of life than non-disabled patients, 53% returned to at least their baseline mRS, those treated faster had better outcome, and there was no increased bleeding risk. Comparing PD patients treated by MSU versus EMS, 90-day uw-mRS was 0.42 versus 0.36 (p = 0.07) and 57% versus 46% returned to at least their baseline mRS. There was no interaction between disability status and MSU versus EMS group assignment (p = 0.67) for 90-day uw-mRS.
PD did not prevent the benefit of faster treatment with tPA in the BEST-MSU study. Our data support inclusion of PD patients in the MSU management paradigm.
由于预先存在残疾（PD）的患者通常被排除在临床试验之外，因此针对这些患者的急性中风治疗的数据很少。最近一项关于移动卒中单元（MSU）的试验表明，MSU 可加快治疗速度并改善预后，且纳入了 PD 患者。
确定组织型纤溶酶原激活剂（tPA）治疗 PD 患者的疗效，以及 MSU 与急诊医疗服务（EMS）管理之间的差异。
主要结局指标为效用加权改良 Rankin 量表（uw-mRS）评分。线性和逻辑回归模型比较了 PD 患者与非 PD 患者、MSU 治疗的 PD 患者与标准 EMS 管理的 PD 患者之间的结局。比较了时间指标、安全性、生活质量和医疗保健利用率。
在 1047 名符合 tPA 治疗条件的缺血性卒中患者中，254 名患者存在 PD（基线 mRS 2-5），793 名患者无 PD（基线 mRS 0-1）。尽管 PD 患者 90 天 uw-mRS 评分较差、死亡率较高、医疗保健利用率较高、生活质量较差，但仍有 53%的患者恢复到基线 mRS 水平以上，治疗速度较快的患者预后较好，且出血风险并未增加。与 EMS 相比，MSU 治疗的 PD 患者 90 天 uw-mRS 评分分别为 0.42 分和 0.36 分（p=0.07），57%的患者恢复到基线 mRS 水平以上，46%的患者恢复到基线 mRS 水平以上。残疾状况和 MSU 与 EMS 分组之间无交互作用（p=0.67）。
在 BEST-MSU 研究中，PD 并未阻止 PD 患者更快接受 tPA 治疗带来的获益。我们的数据支持将 PD 患者纳入 MSU 管理模式。
