The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial
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Le résumé fourni par la source
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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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial
- Date Crossref
- 11/09/2024
- Éditeur
- SAGE Publications
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Siriraj Hospital Department of Medicine pays non établi dans la noticeÉtablissement de santé
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University of Calgary Department of Community Health Sciences pays non établi dans la noticeUniversité ou école supérieure
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Mahidol University pays non établi dans la noticeUniversité ou école supérieure
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Université de Tours pays non établi dans la noticeUniversité ou école supérieure
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Centre Hospitalier Universitaire de Tours pays non établi dans la noticeÉtablissement de santé
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St. Michael's Hospital Department of Medicine pays non établi dans la noticeÉtablissement de santé
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Université de Montréal Department of Clinical Neurosciences pays non établi dans la noticeUniversité ou école supérieure
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London Health Sciences Centre pays non établi dans la noticeÉtablissement de santé
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Health Sciences Centre pays non établi dans la noticeÉtablissement de santé
Department of Medicine — Siriraj Hospital, Department of Community Health Sciences — University of Calgary et Mahidol University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.