Department of Neurology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
Eur Stroke J. 2023 Sep;8(3):647-654. doi: 10.1177/23969873231173274. Epub 2023 May 11.
High systolic blood pressure (SBP) is associated with poor functional outcome. We analysed whether the association of SBP with outcomes after endovascular treatment (EVT) is modified by prior intravenous thrombolysis (IVT).
This was a post-hoc analysis of MR CLEAN-NO IV, a randomised trial of IVT with alteplase followed by EVT versus EVT alone, within 4.5 h from stroke onset. SBP was recorded on hospital admission. The primary outcome was 90-day modified Rankin Scale (mRS) score and secondary outcomes included symptomatic intracranial haemorrhage (sICH) and successful reperfusion (eTICI 2b-3), analysed with (ordinal) logistic regression. Estimates were calculated per 10 mmHg change in SBP. We assessed whether IVT modified the associations of SBP with these outcomes using multiplicative interaction terms.
Of 539 randomised patients, 266 received IVT. The association of SBP with mRS score was J-shaped, with an inflection point at 150 mmHg. Using 150 mmHg as a reference point, SBPs higher than 150 mmHg were associated with poor functional outcome (acOR: 1.23, 95% CI: 1.09-1.38), but lower SBPs were not (acOR: 1.14, 95% CI: 0.99-1.30). Higher SBP was not associated with the risk of sICH (aOR: 1.09, 95% CI: 0.93-1.27) nor with the probability of successful reperfusion (aOR: 1.00, 95% CI: 0.91-1.10). Our main result was that we found no effect modification by IVT (-values for interaction, mRS = 0.94; sICH = 0.26; successful reperfusion = 0.58).
There was no effect modification of IVT with SBP for any of the clinical outcomes. Therefore, the level of SBP (if ⩽185/110 mmHg) should not guide IVT decisions in patients otherwise eligible for both IVT and EVT within the 4.5-h time window.
ISRCTN80619088, https://www.isrctn.com/ISRCTN80619088.
收缩压（SBP）升高与功能预后不良有关。我们分析了 SBP 与血管内治疗（EVT）后结局的关系是否受静脉溶栓（IVT）的影响。
这是 MR CLEAN-NO IV 的事后分析，该研究是一项随机试验，比较了在发病后 4.5 小时内使用阿替普酶进行 IVT 后再进行 EVT 与单独进行 EVT 的效果。入院时记录 SBP。主要结局是 90 天改良 Rankin 量表（mRS）评分，次要结局包括症状性颅内出血（sICH）和成功再灌注（eTICI 2b-3），采用（有序）逻辑回归进行分析。估计值是根据 SBP 每变化 10mmHg 计算的。我们使用乘法交互项评估 IVT 是否改变了 SBP 与这些结局的关联。
在 539 名随机患者中，266 名接受了 IVT。SBP 与 mRS 评分的关系呈 J 形，拐点为 150mmHg。以 150mmHg 为参考点，高于 150mmHg 的 SBP 与不良功能结局相关（调整后的优势比[acOR]：1.23，95%置信区间[CI]：1.09-1.38），但较低的 SBP 则没有（acOR：1.14，95% CI：0.99-1.30）。较高的 SBP 与 sICH 风险（调整后的比值比[aOR]：1.09，95%CI：0.93-1.27）或成功再灌注的可能性（调整后的比值比[aOR]：1.00，95%CI：0.91-1.10）无关。我们的主要结果是，我们没有发现 IVT 对任何临床结局的 SBP 有影响修饰作用（交互检验值，mRS=0.94；sICH=0.26；成功再灌注=0.58）。
在任何临床结局中，IVT 对 SBP 均无影响修饰作用。因此，如果患者符合 4.5 小时时间窗内同时进行 IVT 和 EVT 的条件，SBP（如果 ⩽185/110mmHg）水平不应指导 IVT 决策。
ISRCTN80619088，https://www.isrctn.com/ISRCTN80619088。
Zotero 插件
