Association of baseline blood pressure and outcomes in etiology subtypes of large vessel occlusion stroke: Data from ANGEL-ACT registry

IF 3 3区 医学 Q2 CLINICAL NEUROLOGY
Haifeng Xu , Dapeng Sun , Ligang Song , Dapeng Mo , Ning Ma , Anxin Wang , Feng Gao , Xuelei Zhang , Baixue Jia , Zhongrong Miao , ANGEL-ACT study group
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引用次数: 0

Abstract

Background

Blood pressure (BP) management at the initial stage of stroke caused by large-vessel occlusion (LVO) remains challenging. We assessed the association between baseline BP and clinical and safety outcomes of endovascular treatment (EVT) in different stroke etiologies.

Methods

Patients with acute ischemic stroke and anterior circulation LVO were screened from a prospective, multicenter registry of EVT from November 2017 to March 2019. The primary outcome was poor 90-day outcome (modified Rankin Scale score 3–6). The safety outcome was 24 h post-procedure parenchymal hematoma (PH). The Trial of Org 101072 in Acute Stroke Treatment criteria were used for etiologic stroke classification. Restricted cubic spline and binary logistic regression analysis were performed to examine the association between study outcomes and natural log-transformed BP.

Results

In subgroup analyses, a U-shaped correlation existed between baseline mean arterial pressure (MAP) and poor outcome in large-artery atherosclerosis stroke only. Higher MAP was an independent risk factor compared with a central reference value (≥ 133 mm Hg vs 96–115 mm Hg; adjusted OR [aOR], 2.50; 95 % CI, 1.09 to 5.71, P = 0.030). Whereas elevated MAP was associated with PH (aOR, 1.58; 95 % CI 1.04 to 2.39, P = 0.030 for a ln10-unit increase in natural log-transformed MAP) in the range <110 mm Hg exclusively for cardioembolic stroke.

Conclusion

Whether it is cause or epiphenomenon, baseline BP was associated with 90-day outcome in large-artery atherosclerosis stroke, whereas in cardioembolic stroke baseline BP was correlated with post-procedure PH within a certain range. Identifying these features based on etiological subtypes may offer a reference for BP management in acute LVO stroke.

Abstract Image

大血管闭塞性卒中病因亚型中基线血压与预后的关系:来自 ANGEL-ACT 登记处的数据。
背景:由大血管闭塞(LVO)引起的卒中初期的血压(BP)管理仍然具有挑战性。我们评估了不同卒中病因的基线血压与血管内治疗(EVT)的临床和安全结果之间的关系:2017年11月至2019年3月,我们从EVT前瞻性多中心登记中筛选出急性缺血性卒中和前循环LVO患者。主要结果是90天不良预后(改良Rankin量表评分3-6分)。安全性结果为术后24小时实质血肿(PH)。急性卒中治疗中的 Org 101072 试验标准用于卒中病因分类。对研究结果与自然对数转换血压之间的关系进行了限制性三次样条分析和二元逻辑回归分析:结果:在亚组分析中,基线平均动脉压(MAP)与仅大动脉粥样硬化性卒中的不良预后之间存在 U 型相关性。与中心参考值相比,更高的 MAP 是一个独立的风险因素(≥ 133 mm Hg vs 96-115 mm Hg;调整 OR [aOR],2.50;95% CI,1.09 至 5.71,P=0.030)。而 MAP 升高与 PH 相关(aOR,1.58;95% CI,1.04 至 2.39,P=0.030,自然对数转换后的 MAP 增加 ln10 单位),在小于 110 mm Hg 的范围内仅与心肌栓塞性卒中相关:结论:无论是病因还是表象,基线血压与大动脉粥样硬化性卒中的 90 天预后相关,而心肌栓塞性卒中的基线血压在一定范围内与术后 PH 相关。根据病因亚型确定这些特征可为急性低密度脂蛋白血症卒中的血压管理提供参考。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Neuroradiology
Journal of Neuroradiology 医学-核医学
CiteScore
6.10
自引率
5.70%
发文量
142
审稿时长
6-12 weeks
期刊介绍: The Journal of Neuroradiology is a peer-reviewed journal, publishing worldwide clinical and basic research in the field of diagnostic and Interventional neuroradiology, translational and molecular neuroimaging, and artificial intelligence in neuroradiology. The Journal of Neuroradiology considers for publication articles, reviews, technical notes and letters to the editors (correspondence section), provided that the methodology and scientific content are of high quality, and that the results will have substantial clinical impact and/or physiological importance.
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