Response by Mistry and Khatri to Letter Regarding Article, "Blood Pressure After Endovascular Therapy for Ischemic Stroke (BEST): A Multicenter Prospective Cohort Study".
Response by Mistry and Khatri to Letter Regarding Article, "Blood Pressure After Endovascular Therapy for Ischemic Stroke (BEST): A Multicenter Prospective Cohort Study".
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Mistry 和 Khatri 对有关文章“缺血性中风血管内治疗 (BEST) 后的血压：多中心前瞻性队列研究”的信件的回应。
DOI：
10.1161/strokeaha.119.028470
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发表时间：
2020
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,EvaA;Khatri,Pooja
我们非常感谢对 Anadani 等人的文章的兴趣。 BEST（血管内卒中治疗后的血压）被设计为一项前瞻性、多机构研究，具有预先设定的假设和分析计划，旨在确定血管内治疗后的数据驱动的收缩压峰值 (SBP) 目标，最好地将良好的功能结果与不良的功能结果区分开来。 1 我们故意不监督我们的分析来为未来的随机试验生成明显可行的 SBP 目标。通过减少先前回顾性研究固有的偏差以及通过集中数据监控进行协议化数据收集，BEST 研究的结果得到了加强。我们的结果与之前的研究 2-4 一致，这些研究发现类似的峰值 SBP 目标与较差的功能结果最相关。我们感谢阿纳达尼等人在大型回顾性队列中验证我们的发现的尝试。他们的目标 169.5 毫米汞柱也可能被考虑在未来的临床试验中进行测试。然而，这一目标将受到同样的限制——观察到/实现的介入 SBP 值与护理标准 SBP 值 (180 mm Hg) 之间缺乏分离——正如 Anadani 等人所正确建议的那样。 BEST 研究中生成的目标为未来临床试验中测试的峰值 SBP 目标的选择提供了信息。在 BEST 研究中，未发现峰值 SBP 与 90 天功能结果之间存在 U 形关系。因此，在未来的临床试验中，研究者可以酌情采用较低的峰值收缩压目标，同时考虑到诱发相对低血压的潜在有害影响（即梗塞体积和功能结果恶化）。
We greatly appreciate interest in our article by Anadani et al. BEST (Blood Pressure After Endovascular Stroke Therapy) was designed as a prospective, multi-institutional study with a prespecified hypothesis and analysis plan to identify a data-driven target of peak systolic blood pressure (SBP) after endovascular therapy that best dichotomizes good functional outcomes from bad. 1 We intentionally did not supervise our analysis to generate a perceivably feasible SBP target for a future randomized trial. The results of the BEST study are strengthened by reduction of the biases inherent to prior retrospective studies as well as protocolized data collection with centralized data monitoring. Our results are consistent with prior studies2–4 that have found a similar peak SBP target that best associated with worse functional outcomes. We appreciate the attempt by Anadani et al to validate our findings in their large retrospective cohort. Their target of 169.5 mm Hg may also be considered for testing in future clinical trials. However, this target will be a subject to the same limitation–lack of separation between observed/achieved interventional SBP values and the standard-of-care SBP value (180 mm Hg)–as Anadani et al have rightly suggested. The target generated in the BEST study informs the selection of a peak SBP goal for testing in future clinical trials. In the BEST study, a U-shaped relationship between peak SBP and 90-day functional outcome was not identified. Thus, lower targets of peak SBP could be employed in such future clinical trial at the investigator’s discretion, while accounting for the potentially harmful effects (ie, worsening of infarct volume and functional outcomes) of induced relative hypotension.
影响因子：
8.3
作者：
Mistry, Eva A.;Sucharew, Heidi;Khatri, Pooja
通讯作者：
Khatri, Pooja