Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST) A Multicenter Prospective Cohort Study
Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST) A Multicenter Prospective Cohort Study
复制标题
DOI：
10.1161/strokeaha.119.026889
复制
发表时间：
2019-12-01
期刊：
影响因子：
8.3
通讯作者：
Khatri, Pooja
中科院分区：
文献类型：
--
作者：
Mistry, Eva A.;Sucharew, Heidi;Khatri, Pooja
背景和目的-为了确定血管内治疗(EVT)后峰值收缩压(SBP)的特定阈值，最好地区分功能结果的好与坏(先验假设为160毫米汞柱)，我们进行了一项前瞻性、多中心、队列研究，采用预先指定的分析计划。方法：从2017年11月至2018年7月，在美国12个综合性卒中中心连续入选接受EVT治疗的前缺血性卒中的成人患者。记录所有患者EVT后24小时内的SBP值。用Youden指数确定最能区分90天改良Rankin评分的主要结果的峰值SBP阈值(0~2分对3~6分)。结果：在485名入选患者中(中位年龄69[四分位数范围，57-79岁；51%女性)，峰值SBP为158 mm Hg与二分改良Rankin量表评分的最大差异(绝对风险降低19%)相关。SBP>；158毫米汞柱峰值导致改良Rankin量表评分3至6分的可能性增加(优势比，2.24[1.52-3.29]，P158在未经调整的分析中有不良结果的可能性增加，但在经调整的分析中不是。观察到的效应大小与先前的研究相似。这一发现应该在未来的靶向EVT后抗高血压治疗的随机试验中进行进一步的测试。
Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure (SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mmHg), we conducted a prospective, multicenter, cohort study with a prespecified analysis plan.Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017 to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVT were recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized 90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomes was quantified using multiple logistic regression.Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBP of 158 mmHg was associated with the largest difference in the dichotomous modified Rankin Scale score (absolute risk reduction of 19%). Having a peak SBP >158 mmHg resulted in an increased likelihood of modified Rankin Scale score 3 to 6 (odds ratio, 2.24 [1.52-3.29], P158 had an increased likelihood of having a bad outcome in unadjusted, but not in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testing in a future randomized trial of goal-targeted post-EVT antihypertensive treatment.