Chen Chih-Hao, Shoamanesh Ashkan, Colorado Pablo, Saad Feryal, Lemmens Robin, De Marchis Gian Marco, Caso Valeria, Xu Lizhen, Heenan Laura, Masjuan Jaime, Christensen Hanne, Khatri Pooja, Mundl Hardi, Hart Robert G, Smith Eric E
Department of Clinical Neurosciences, University of Calgary, Canada (C.-H.C., F.S., E.E.S.).
Department of Neurology, National Taiwan University Hospital, Taipei (C.-H.C.).
Stroke. 2025 Jul;56(7):1730-1737. doi: 10.1161/STROKEAHA.124.049188. Epub 2025 Apr 8.
Hemorrhagic infarction (HI) of acute ischemic stroke is frequent. Whether radiologically detected HI affects stroke outcomes has been less explored.
This was a secondary analysis of the PACIFIC-STROKE trial (Proper Dosing and Safety of the Oral FXIa Inhibitor BAY 2433334 in Patients Following Acute Noncardioembolic Stroke), which enrolled patients with acute noncardioembolic ischemic stroke receiving either asundexian or placebo in addition to guideline-based antiplatelet therapy. All patients received brain magnetic resonance imaging within 120 hours after stroke onset. Patients with hemorrhagic transformation detected on iron-sensitive sequences and classified as HI (H1 and H2) by the Heidelberg Bleeding Classification were included in the analysis. Primary outcome was poor functional outcome, defined by a modified Rankin Scale score of 2 to 6 at 90 days after stroke.
From 1745 patients with adequate baseline brain magnetic resonance imaging (median, 47.8 hours; interquartile range, 28.2-69.4 hours after symptom onset), 10 with parenchymal hemorrhage and 191 without modified Rankin Scale score were excluded. Of the 1544 patients (mean age, 67 years; 67% male), 248 (16.1%) had HI type 1, and 189 (12.2%) had HI type 2. The proportion of patients with poor functional outcome was 27.4% (68/248) in HI type 1, 25.9% (49/189) in HI type 2, and 23.0% (255/1107) in no HI groups. In the multivariable logistic regression model adjusting for stroke severity, infarct size, type of iron-sensitive sequences used, and other covariates, the presence of HI type 1 (adjusted odds ratio, 1.05 [95% CI, 0.74-1.51]) or HI type 2 (adjusted odds ratio, 0.88 [95% CI, 0.57-1.34]) were not associated with poor functional outcome. Of note, the type of iron-sensitive sequences did not modify the results.
The presence of HI did not lead to poor functional outcome on the modified Rankin Scale in patients with acute noncardioembolic ischemic stroke.
急性缺血性卒中的出血性梗死（HI）很常见。放射学检测到的HI是否会影响卒中预后尚未得到充分研究。
这是对PACIFIC-STROKE试验（急性非心源性栓塞性卒中患者口服FXIa抑制剂BAY 2433334的合适剂量与安全性）的二次分析，该试验纳入了急性非心源性栓塞性缺血性卒中患者，这些患者除接受基于指南的抗血小板治疗外，还接受阿孙西坦或安慰剂治疗。所有患者在卒中发作后120小时内接受脑部磁共振成像检查。在铁敏感序列上检测到出血转化并根据海德堡出血分类法归类为HI（H1和H2）的患者纳入分析。主要结局是功能预后不良，定义为卒中后90天时改良Rankin量表评分为2至6分。
在1745例有充分基线脑部磁共振成像的患者中（症状发作后的中位数为47.8小时；四分位间距为28.2 - 69.4小时），排除了10例有脑实质出血和191例无改良Rankin量表评分的患者。在1544例患者（平均年龄67岁；67%为男性）中，248例（16.1%）有1型HI，189例（12.2%）有2型HI。1型HI患者中功能预后不良的比例为27.4%（68/248），2型HI患者中为25.9%（49/189），无HI组中为23.0%（255/1107）。在调整了卒中严重程度、梗死面积、所用铁敏感序列类型及其他协变量的多变量逻辑回归模型中，1型HI（调整后的比值比，1.05 [95%CI，0.74 - 1.51]）或2型HI（调整后的比值比，0.88 [95%CI，0.57 - 1.34]）与功能预后不良无关。值得注意的是，铁敏感序列类型并未改变结果。
急性非心源性栓塞性缺血性卒中患者中，HI的存在并未导致改良Rankin量表上的功能预后不良。
