Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST) A Multicenter Prospective Cohort Study

被引:80
作者
Mistry, Eva A. [1 ]
Sucharew, Heidi [2 ]
Mistry, Akshitkumar M. [3 ]
Mehta, Tapan [4 ]
Arora, Niraj [5 ]
Starosciak, Amy K. [6 ]
La Rosa, Felipe De Los Rios [6 ]
Siegler, James Ernest [7 ]
Barnhill, Natasha R. [8 ]
Patel, Kishan [9 ]
Assad, Salman [10 ]
Tarboosh, Amjad [10 ]
Dakay, Katarina [11 ]
Salwi, Sanjana [12 ]
Cruz, Aurora S. [13 ]
Wagner, Jeffrey [14 ]
Fortuny, Enzo [13 ]
Bennett, Alicia [14 ]
James, Robert F. [13 ]
Jagadeesan, Bharathi [4 ]
Streib, Christopher [4 ]
O'Phelan, Kristine [5 ]
Kasner, Scott E. [7 ]
Weber, Stewart A. [8 ]
Chitale, Rohan [3 ]
Volpi, John J. [9 ]
Mayer, Stephan [10 ]
Yaghi, Shadi [15 ]
Jayaraman, Mahesh, V [11 ]
Khatri, Pooja [16 ]
机构
[1] Vanderbilt Univ, Dept Neurol, Med Ctr, 221 Kirkland Hall, Nashville, TN 37235 USA
[2] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA
[3] Vanderbilt Univ, Med Ctr, Dept Neurosurg, 221 Kirkland Hall, Nashville, TN 37235 USA
[4] Univ Minnesota, Dept Neurol & Neurosurg, Minneapolis, MN USA
[5] Jackson Mem Hosp, Dept Neurol, Miami, FL 33136 USA
[6] Baptist Hlth South Florida, Miami, FL USA
[7] Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
[8] Oregon Hlth & Sci Univ, Dept Neurol, Portland, OR 97201 USA
[9] Houston Methodist Hosp, Dept Neurol, Houston, TX 77030 USA
[10] Henry Ford Hosp, Dept Neurol, Detroit, MI 48202 USA
[11] Rhode Isl Hosp, Dept Neurol, Providence, RI USA
[12] Vanderbilt Univ, Sch Med, Nashville, TN 37212 USA
[13] Univ Louisville, Sch Med, Dept Neurosurg, Louisville, KY 40292 USA
[14] Blue Sky Neurol, Aurora, CO USA
[15] New York Univ Langone Hlth, Dept Neurol, Brooklyn, NY USA
[16] Univ Cincinnati, Dept Neurol & Rehabil Med, Cincinnati, OH USA
基金
美国国家卫生研究院;
关键词
antihypertensive agents; blood pressure; brain ischemia; reperfusion; retrospective studies; CEREBRAL-ARTERY FUNCTION; THROMBECTOMY; OUTCOMES; REPERFUSION; CARE;
D O I
10.1161/STROKEAHA.119.026889
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure (SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mmHg), we conducted a prospective, multicenter, cohort study with a prespecified analysis plan. Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017 to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVT were recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized 90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomes was quantified using multiple logistic regression. Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBP of 158 mmHg was associated with the largest difference in the dichotomous modified Rankin Scale score (absolute risk reduction of 19%). Having a peak SBP >158 mmHg resulted in an increased likelihood of modified Rankin Scale score 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment for prespecified variables). Conclusions-A peak post-EVT SBP of 158 mmHg was prospectively identified to best discriminate good from bad functional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, but not in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testing in a future randomized trial of goal-targeted post-EVT antihypertensive treatment.
引用
收藏
页码:3449 / 3455
页数:7
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