Determinants of early outcomes in patients with acute ischemic stroke and proximal artery occlusion.
Determinants of early outcomes in patients with acute ischemic stroke and proximal artery occlusion.
复制标题
急性缺血性卒中和近端动脉闭塞患者早期结局的决定因素。
DOI：
10.1016/j.jstrokecerebrovasdis.2014.03.020
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Rost,Natalia
中科院分区：
文献类型：
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作者：
LaBuzetta,JamieNicole;Yoo,AlbertJ;Ali,Syed;Fitzpatrick,Kaitlin;Leslie-Mazwi,Thabele;Hirsch,JoshuaA;Schwamm,Lee;Rost,Natalia
背景：仅一小部分急性缺血性卒中（AIS）患者接受静脉组织纤溶酶原激活剂（IV tPA）治疗后近端动脉闭塞（PAO）再通，但在该患者亚组中，连续性或替代性动脉内治疗（IAT）的益处尚未得到充分证实。我们评估了早期中风后的结果在一个队列的AIS患者PAO归类为“可能受益”（LTB）从IAT使用预先指定的criteria.MethodsUsing一个预先指定的协议，193例患者从我们的机构中风数据库承认2007年1月1日至2011年12月31日，前瞻性地认为LTB从IAT。Logistic回归被用来确定有利的独立预测因素（出院回家或急性康复）与不利的（出院到专业护理设施，临终关怀，或在医院死亡率）outcome.ResultsOf的患者，29.5%只接受IV tPA，11.4%只接受IAT，37.8%两者兼而有之。总住院死亡率为19.2%。在单变量分析中，年龄（比值比[OR]，0.95; 95%置信区间[CI]，0.93 - 0.98）、IV tPA（OR，2.3; 95% CI，1.2-4.3）和房颤病史（OR，0.5; 95% CI，0.28 - 0.97）与结局相关。IAT的影响无统计学显著性（OR，1.3; 95% CI，0.7 -2.3;P= 0.4）。在多变量分析中，有利结局的唯一独立预测因素是IV tPA给药（OR，2.4; 95% CI，1.2-5.0）。有利的中风后结果的几率显着降低（OR，0.3; 95%CI，0.1 - 0.6;P= 0.0006）在那些既不接受IV tPA也IAT.ConclusionsIn AIS患者PAO认为最有可能受益于IAT，IV tPA独立预测有利的结果。这些数据强化了向所有合格患者提供早期IV tPA的建议。
BackgroundProximal artery occlusions (PAO) recanalize in only a small percentage of acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV tPA) alone, yet the benefits of adjunctive or substitutive intra-arterial therapy (IAT) in this patient subgroup are not well established. We evaluated early poststroke outcomes in a cohort of AIS patients with PAO categorized as “likely to benefit” (LTB) from IAT using prespecified criteria.MethodsUsing a prespecified protocol, 193 patients from our institutional stroke database admitted between January 1, 2007, and December 31, 2011, were prospectively deemed LTB from IAT. Logistic regression was used to determine independent predictors of favorable (discharge to home or acute rehabilitation) versus unfavorable (discharge to skilled nursing facility, hospice, or in-hospital mortality) outcome.ResultsOf the patients included, 29.5% received IV tPA only, 11.4% underwent IAT only, and 37.8% had both. Overall in-hospital mortality was 19.2%. In a univariate analysis, age (odds ratio [OR], .95; 95% confidence interval [CI], .93-.98), IV tPA (OR, 2.3; 95% CI, 1.2-4.3), and history of atrial fibrillation (OR, .5; 95% CI, .28-.97) were associated with outcome. Effect of IAT was not statistically significant (OR, 1.3; 95% CI, .7-2.3;P= .4). In multivariate analysis, the only independent predictor of favorable outcome was IV tPA administration (OR, 2.4; 95% CI, 1.2-5.0). The odds of favorable poststroke outcome were significantly lowered (OR, .3; 95% CI, .1-.6;P= .0006) in those receiving neither IV tPA nor IAT.ConclusionsIn AIS patients with PAO thought most likely to benefit from IAT, IV tPA independently predicted favorable outcomes. These data reinforce the recommendation to provide early IV tPA to all eligible patients.