Chitapa Kaveeta, Ibrahim Alhabli, Fouzi Bala, MacKenzie Horn, Faysal Benali, Shelagh B Coutts, Atif Zafar, Olena Bereznyakova, Alexander Khaw, Houman Khosravani, Gary Hunter, Aleksander Tkach, Dar Dowlatshahi, Luciana Catanese, Chrysi Bogiatzi, Ramana Appireddy, Brian H Buck, Richard H Swartz, Tolulope T Sajobi, Mohammed Almekhlafi, Andrew M Demchuk, Aravind Ganesh, Bijoy Menon, Nishita Singh
{"title":"急性缺血性脑卒中 ASPECTS 的治疗效果：AcT 试验分析","authors":"Chitapa Kaveeta, Ibrahim Alhabli, Fouzi Bala, MacKenzie Horn, Faysal Benali, Shelagh B Coutts, Atif Zafar, Olena Bereznyakova, Alexander Khaw, Houman Khosravani, Gary Hunter, Aleksander Tkach, Dar Dowlatshahi, Luciana Catanese, Chrysi Bogiatzi, Ramana Appireddy, Brian H Buck, Richard H Swartz, Tolulope T Sajobi, Mohammed Almekhlafi, Andrew M Demchuk, Aravind Ganesh, Bijoy Menon, Nishita Singh","doi":"10.1177/17474930241273561","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.</p><p><strong>Aims: </strong>We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.</p><p><strong>Methods: </strong>Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity.</p><p><strong>Results: </strong>Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes.</p><p><strong>Conclusion: </strong>Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase.</p><p><strong>Data access statement: </strong>Data shall made available on reasonable request from the PI (BMM).</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241273561"},"PeriodicalIF":6.3000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.\",\"authors\":\"Chitapa Kaveeta, Ibrahim Alhabli, Fouzi Bala, MacKenzie Horn, Faysal Benali, Shelagh B Coutts, Atif Zafar, Olena Bereznyakova, Alexander Khaw, Houman Khosravani, Gary Hunter, Aleksander Tkach, Dar Dowlatshahi, Luciana Catanese, Chrysi Bogiatzi, Ramana Appireddy, Brian H Buck, Richard H Swartz, Tolulope T Sajobi, Mohammed Almekhlafi, Andrew M Demchuk, Aravind Ganesh, Bijoy Menon, Nishita Singh\",\"doi\":\"10.1177/17474930241273561\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.</p><p><strong>Aims: </strong>We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.</p><p><strong>Methods: </strong>Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity.</p><p><strong>Results: </strong>Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes.</p><p><strong>Conclusion: </strong>Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. 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The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.
Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.
Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.
Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity.
Results: Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes.
Conclusion: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase.
Data access statement: Data shall made available on reasonable request from the PI (BMM).
期刊介绍：
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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