Defining mild stroke: outcomes analysis of treated and untreated mild stroke patients.
Defining mild stroke: outcomes analysis of treated and untreated mild stroke patients.
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DOI：
10.1016/j.jstrokecerebrovasdis.2015.01.037
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发表时间：
2015-06
影响因子：
2.5
通讯作者：
Meyer, Brett C.
中科院分区：
文献类型：
--
作者：
Spokoyny, Ilana;Raman, Rema;Ernstrom, Karin;Khatri, Pooja;Meyer, Dawn M.;Hemmen, Thomas M.;Meyer, Brett C.
关键词：
轻度缺陷是静脉注射 rtPA 治疗急性缺血性卒中的相对禁忌症。然而，什么是“轻度”赤字却很模糊。先前的研究表明，轻度中风患者在出院时和 90 天后的残疾率很高。我们调查了新定义的应用是否改变了总体残疾率，并评估了溶栓的效果。该分析包括来自前瞻性连续患者登记（UCSD SPOTRIAS 数据库，2003-2014）的所有成年急性缺血性中风患者，这些患者具有 90 天 mRS 评分，使用以下任一方法定义为“轻度”：NIHSS 0-5 或 TREAT 特别工作组定义（NIHSS 0-5 和基于预先指定综合征的非致残）。使用这两种定义对治疗和未治疗患者的二分法 90 天 mRS 进行比较。在 802 名具有 mRS 评分的缺血性中风患者中，184 名基线 mRS(0) 且符合 TREAT 标准； 45 例（24.5%）接受 rtPA 治疗。在接受治疗的患者中，35.6% 的患者出现 90 天 mRS(2-6)，而未经治疗组的这一比例为 28.8%，在调整基线 NIHSS 后无显着差异 (p=0.47)。 45 名接受治疗的患者中没有一人出现有症状的出血。使用更简单的 NIHSS 0-5 定义，结果相似。无论采用何种治疗或采用轻度定义，约三分之一的轻度中风患者在 90 天时无法实现功能独立，这令人质疑 IV rtPA 对轻度中风的治疗效果以及“轻度”的适当定义。需要进行随机研究来确定 rtPA 对轻度中风患者的治疗效果。
Mild deficit is a relative contraindication to administration of IV rtPA for acute ischemic stroke. However, what constitutes “mild” deficit is vague. Prior studies showed patients with mild strokes have substantial disability rates at hospital discharge and at 90 days. We investigated whether the application of a new definition altered the rates of disability overall, and assessed the effects of thrombolysis. This analysis included all adult acute ischemic stroke patients from a prospective registry of consecutive patients (UCSD SPOTRIAS database, 2003-2014) with 90-day mRS score available who were defined as “mild” using either: NIHSS 0-5 or a TREAT Task Force definition (NIHSS 0-5 and non-disabling based on pre-specified syndromes). Dichotomized 90-day mRS were compared between treated and untreated patients using the two definitions. Of 802 ischemic stroke patients with mRS scores available, 184 had baseline mRS(0) and met TREAT criteria; 45(24.5%) were rtPA-treated. Among treated patients, 35.6% had 90-day mRS(2-6), versus 28.8% in the untreated group, a non-significant difference after adjusting for baseline NIHSS (p=0.47). None of the 45 treated patients had symptomatic hemorrhage. Outcomes were similar using the simpler NIHSS 0-5 definition. About one-third of mild stroke patients were not functionally independent at 90 days, irrespective of treatment or mild definition applied, calling into question the treatment efficacy of IV rtPA for mild strokes as well as what constitutes an appropriate definition of “mild”. Randomized studies are necessary to determine rtPA treatment efficacy in mild stroke patients.
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影响因子：
8.3
作者：
Re-examining Acute Eligibility for Thrombolysis (TREAT) Task Force:;Levine SR;Khatri P;Broderick JP;Grotta JC;Kasner SE;Kim D;Meyer BC;Panagos P;Romano J;Scott P;NINDS rt-PA Stroke Trial Investigators
通讯作者：
NINDS rt-PA Stroke Trial Investigators
影响因子：
9.9
作者：
Barber, PA;Zhang, J;Buchan, AM
通讯作者：
Buchan, AM
影响因子：
6.7
作者：
Frank, Benedikt;Fulton, Rachael L.;Lees, Kennedy R.
通讯作者：
Lees, Kennedy R.
影响因子：
8.3
作者：
Khatri P;Kleindorfer DO;Yeatts SD;Saver JL;Levine SR;Lyden PD;Moomaw CJ;Palesch YY;Jauch EC;Broderick JP
通讯作者：
Broderick JP
影响因子：
8.3
作者：
Leira, Enrique C.;Ludwig, Bryan R.;Adams, Harold P., Jr.
通讯作者：
Adams, Harold P., Jr.