Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study.
Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study.
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DOI：
10.1161/strokeaha.119.027549
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发表时间：
2020-02
期刊：
影响因子：
8.3
通讯作者：
de Havenon A
中科院分区：
文献类型：
--
作者：
Mistry EA;Mehta T;Mistry A;Arora N;Starosciak AK;De Los Rios La Rosa F;Siegler JE 3rd;Chitale R;Anadani M;Yaghi S;Khatri P;de Havenon A
虽然较高的血压变异性（BPV）与卒中后较差的功能预后相关，但在血管内治疗（EVT）治疗的大血管闭塞卒中中，这种关联尚未得到很好的证实。在这项缺血性卒中血管内治疗后血压（BEST）的事后分析中，我们确定了BPV与预后不良（90天mRS 3-6）或死亡的关联。我们使用5种方法计算了EVT后24小时内的收缩压和舒张压的BPV，然后将BPV分为三分位数，并在逻辑回归中比较了最高和最低的四分位数。在我们分析的443例患者中，259例（58.5%）预后不良，79/443例（17.8%）死亡。在预后不良或死亡的患者中，所有BPV测量值均显著升高，但收缩期BPV比舒张期BPV差异更明显。在logistic回归中，收缩期BPV的最高分位数一致预测预后不良（OR为1.8 ~ 3.5，均p<0.05）。收缩期血压最低的实验组90天内死亡率为10.1%，而血压最高的实验组为25.2% （p<0.001）。在evt治疗的脑卒中患者中，前24小时较高的BPV与较差的90天预后相关。这种关联在收缩期BPV中更为明显。BPV可能对神经预后产生负面影响的机制尚不清楚，但这种关联的一致性值得进一步调查和潜在的干预。
Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). In this post-hoc analysis of Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST), a prospective, multi-center cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome (90-day mRS 3–6) or death. We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile in logistic regression. Of 443 patients in our analysis, 259 (58.5%) had a poor outcome and 79/443 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (OR 1.8 to 3.5, all p<0.05). The rate of death within 90 days was 10.1% in the tertile with the lowest systolic BPV versus 25.2% in the tertile with the highest BPV (p<0.001). In EVT-treated stroke patients, higher BPV in the first 24 hours is associated with worse 90-day outcome. This association was more robust for systolic BPV. The mechanism by which BPV may exert a negative influence on neurologic outcome remains unknown, but the consistency of this association warrants further investigation and potentially intervention.