The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY International Journal of Stroke Pub Date : 2024-09-11 DOI:10.1177/17474930241273561

Chitapa Kaveeta, Ibrahim Alhabli, Fouzi Bala, MacKenzie Horn, Faysal Benali, Shelagh B Coutts, Atif Zafar, Olena Bereznyakova, Alexander Khaw, Houman Khosravani, Gary Hunter, Aleksander Tkach, Dar Dowlatshahi, Luciana Catanese, Chrysi Bogiatzi, Ramana Appireddy, Brian H Buck, Richard H Swartz, Tolulope T Sajobi, Mohammed Almekhlafi, Andrew M Demchuk, Aravind Ganesh, Bijoy Menon, Nishita Singh

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引用次数: 0

Abstract

Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication.

Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase.

Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity.

Results: Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes.

Conclusion: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase.

Data access statement: Data shall made available on reasonable request from the PI (BMM).

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急性缺血性脑卒中 ASPECTS 的治疗效果：AcT 试验分析

背景：目的：我们评估了早期缺血性改变与临床预后的关系，以及静脉注射替奈普酶与阿替普酶之间是否存在差异：数据来自阿替普酶与替奈普酶（AcT）的3期临床试验。研究对象包括前循环中风患者。使用阿尔伯塔省卒中计划早期CT评分（ASPECTS）评估早期缺血性改变。疗效结果包括改良Rankin量表（mRS）0-1分、mRS 0-2分和90天时的顺序mRS。安全性结果包括 24 小时无症状性脑出血（sICH）、随访扫描中的任何出血以及 90 天死亡率。混合效应逻辑回归用于评估ASPECTS[连续和分类（0-4 vs. 5-7 vs. 8-10）]与结果的关系，以及在调整年龄、性别和基线中风严重程度后，这些关系是否会因溶栓类型而改变：在试验的 1577 名患者中，前循环卒中患者 901 名（56.3%）（中位年龄 75 岁 [IQR：65-84]，50.8% 为女性，中位 NIHSS 14 [IQR：17-19]），90d 时 mRS 为 0-1 的 ASPECTS 0-4、5-7 和 8-10 组分别为 1/14（0.3%）、43/160（14.7%）和 252/726（85.1%）。ASPECTS 每下降 1 点，90 天后出现 mRS 0-1 和 mRS 0-2 的几率分别下降 2.7% 和 1.9%，90 天后死亡率上升 1.9%。对接受EVT治疗的人群进行的亚组分析显示了相似的结果。溶栓类型不会改变 ASPECTS 与 90 天 mRS 0-1 之间的关系（P 交互作用为 0.75）。溶栓类型与其他结果之间没有明显的交互作用：与之前的研究相似，我们发现 ASPECTS 每下降一个点，临床和安全性结果都会变差。这种效应在阿替普酶和替奈普酶之间没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.