TY - JOUR
T1 - Predictors and clinical impact of infarct progression rate in the ESCAPE-NA1 trial
AU - Ospel, Johanna Maria
AU - McDonough, Rosalie
AU - Demchuk, Andrew M.
AU - Menon, Bijoy K.
AU - Almekhlafi, Mohammed A.
AU - Nogueira, Raul G.
AU - McTaggart, Ryan A.
AU - Poppe, Alexandre Y.
AU - Buck, Brian H.
AU - Roy, Daniel
AU - Haussen, Diogo C.
AU - Chapot, René
AU - Field, Thalia S.
AU - Jayaraman, Mahesh V.
AU - Tymianski, Michael
AU - Hill, Michael D.
AU - Goyal, Mayank
N1 - Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/9
Y1 - 2022/9
N2 - Background Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making, and outcome prognostication. Objective To estimate infarct progression rate in patients with AIS with large vessel occlusion (LVO) and determine its predictors and impact on clinical outcome. Methods Data are from the ESCAPE-NA1 Trial. Patients with AIS with time from last known well to randomization <6 hours and near-complete reperfusion following endovascular treatment were included. Infarct growth rate (mL/h) was estimated by dividing 24 hour infarct volume (measured by non-contrast CT or diffusion-weighted magnetic resonance imaging) by time from last known well to reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (modified Rankin Scale score 0–2) was determined using multivariable logistic regression. Results Four hundred and nine patients were included in the study. Median infarct progression rate was 4.74 mL/h (IQR 1.25–14.84). Collateral status (β: −0.81 (95% CI −1.20 to −0.41)), Alberta Stroke Program Early CT Score (ASPECTS, β: −0.34 (95% CI −0.46 to −0.23)), blood glucose(β: 0.09 (95% CI 0.02 to 0.16)), and National Institutes of Health Stroke Scale (NIHS score (β: 0.07 (95% CI 0.04 to 0.10)) were associated with log-transformed infarct progression rate. Clinical and imaging baseline variables explained 23% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1 mL/h increase: 0.96 (95% CI 0.95 to 0.98)). Conclusion In this sample of patients presenting within the early time window with LVO and near-complete recanalization, infarct progression rate was significantly associated with good outcome. A significant association between ASPECTS, collateral status, blood glucose, and NIHSS score was observed, but baseline imaging and clinical characteristics explained only a small proportion of the interindividual variance. More research on measurable factors affecting infarct growth is needed.
AB - Background Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making, and outcome prognostication. Objective To estimate infarct progression rate in patients with AIS with large vessel occlusion (LVO) and determine its predictors and impact on clinical outcome. Methods Data are from the ESCAPE-NA1 Trial. Patients with AIS with time from last known well to randomization <6 hours and near-complete reperfusion following endovascular treatment were included. Infarct growth rate (mL/h) was estimated by dividing 24 hour infarct volume (measured by non-contrast CT or diffusion-weighted magnetic resonance imaging) by time from last known well to reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (modified Rankin Scale score 0–2) was determined using multivariable logistic regression. Results Four hundred and nine patients were included in the study. Median infarct progression rate was 4.74 mL/h (IQR 1.25–14.84). Collateral status (β: −0.81 (95% CI −1.20 to −0.41)), Alberta Stroke Program Early CT Score (ASPECTS, β: −0.34 (95% CI −0.46 to −0.23)), blood glucose(β: 0.09 (95% CI 0.02 to 0.16)), and National Institutes of Health Stroke Scale (NIHS score (β: 0.07 (95% CI 0.04 to 0.10)) were associated with log-transformed infarct progression rate. Clinical and imaging baseline variables explained 23% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1 mL/h increase: 0.96 (95% CI 0.95 to 0.98)). Conclusion In this sample of patients presenting within the early time window with LVO and near-complete recanalization, infarct progression rate was significantly associated with good outcome. A significant association between ASPECTS, collateral status, blood glucose, and NIHSS score was observed, but baseline imaging and clinical characteristics explained only a small proportion of the interindividual variance. More research on measurable factors affecting infarct growth is needed.
UR - https://www.scopus.com/pages/publications/85135492205
U2 - 10.1136/neurintsurg-2021-017994
DO - 10.1136/neurintsurg-2021-017994
M3 - Artículo
C2 - 34493575
AN - SCOPUS:85135492205
SN - 1759-8478
VL - 14
SP - 886
EP - 891
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 9
ER -