Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort
Hemorrhagic transformation within 36 hours of a cerebral infarct - Relationships with early clinical deterioration and 3-month outcome in the European Cooperative Acute Stroke Study I (ECASS I) cohort
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DOI：
10.1161/01.str.30.11.2280
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发表时间：
1999-11-01
期刊：
影响因子：
8.3
通讯作者：
Bozzao, L
中科院分区：
文献类型：
--
作者：
Fiorelli, M;Bastianello, S;Bozzao, L
背景和目的：脑梗死早期不同程度出血性转化的临床相关性尚不清楚。我们调查了一项溶栓随机试验的队列，以评估早期和晚期与缺血性卒中前36小时内检测到的出血性梗死（HI）和脑实质血肿（PII）不同亚型相关的临床病程。方法我们利用欧洲急性卒中研究I（ECASS I）的数据库，ECASS I是一项随机、安慰剂对照、静脉注射重组组织型纤溶酶原激活剂治疗急性缺血性卒中的III期临床试验24- 36小时CT结果分为5类：无出血性转化、HI 1型和2型以及PH 1型和2型。我们评估了与出血性转化亚型相关的伴随神经功能恶化和3个月死亡和残疾的风险，而不是无出血。结果-与无出血性转化相比，HI 1、HI 2和PH 1并没有改变早期神经功能恶化、死亡和残疾的风险，然而，在安慰剂组和重组组织纤溶酶原激活剂组中，PH 2对早期神经过程具有破坏性影响（恶化的比值比，32.3; 95%CI，13.4至77.7），3个月死亡（比值比，18.0; 95%CI，8.05至40.1）。残疾的风险也更高，但不显着，PH2.Conclusions早期神经功能恶化和3个月死亡的风险严重增加后PH 2，表明大血肿是唯一类型的出血性转化，可能会改变缺血性卒中的临床过程。
Background and Purpose-The clinical correlates of the varying degrees of early hemorrhagic transformation of a cerebral infarct are unclear. We investigated the cohort of a randomized trial of thrombolysis to assess the early and late clinical course associated with different subtypes of hemorrhagic infarction (HI) and parenchymal hematoma (PII) detected within the first 36 hours of an ischemic stroke.Methods-We exploited the database of the European Cooperative Acute Stroke Study I (ECASS I), a randomized, placebo-controlled, phase III trial of intravenous recombinant tissue plasminogen activator in acute ischemic stroke. Findings on 24- to 36- hour CT were classified into 5 categories: no hemorrhagic transformation, HI types 1 and 2, and PH types 1 and 2. We assessed the risk of concomitant neurological deterioration and of 3-month death and disability associated with subtypes of hemorrhagic transformation, as opposed to no bleeding. Risks were adjusted for age and extent of ischemic damage on baseline CT.Results-Compared with absence of hemorrhagic transformation, HI1, HI2, and PH1 did not modify the risk of early neurological deterioration, death, and disability, whereas, in both the placebo and the recombinant tissue plasminogen activator groups, PH2 had a devastating impact on early neurological course (odds ratio for deterioration, 32.3; 95% CI, 13.4 to 77.7), and on 3-month death (odds ratio, 18.0; 95% CI, 8.05 to 40.1). Risk of disability was also higher, but not significantly, after PH2.Conclusions-Risk of early neurological deterioration and of 3-month death was severely increased after PH2, indicating that large hematoma is the only type of hemorrhagic transformation that may alter the clinical course of ischemic stroke.