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The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.
Kaveeta, Chitapa; Alhabli, Ibrahim; Bala, Fouzi; Horn, MacKenzie; Benali, Faysal; Coutts, Shelagh B; Zafar, Atif; Bereznyakova, Olena; Khaw, Alexander; Khosravani, Houman; Hunter, Gary; Tkach, Aleksander; Dowlatshahi, Dar; Catanese, Luciana; Bogiatzi, Chrysi; Appireddy, Ramana; Buck, Brian H; Swartz, Richard H; Sajobi, Tolulope T; Almekhlafi, Mohammed; Demchuk, Andrew M; Ganesh, Aravind; Menon, Bijoy; Singh, Nishita.
Afiliación
  • Kaveeta C; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Alhabli I; Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • Bala F; Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Horn M; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Benali F; Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France.
  • Coutts SB; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Zafar A; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Bereznyakova O; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Khaw A; Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Khosravani H; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  • Hunter G; Division of Vascular Neurology, Department of Medicine, University of Toronto and St. Michael's Hospital, Toronto, ON, Canada.
  • Tkach A; Department of Clinical Neurosciences, Université de Montréal, Montreal, QC, Canada.
  • Dowlatshahi D; London Health Sciences Centre and Western University, London, ON, Canada.
  • Catanese L; Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
  • Bogiatzi C; Division of Neurology, University of Saskatchewan, Saskatoon, SK, Canada.
  • Appireddy R; Department of Neuroscience, Kelowna General Hospital, Kelowna, BC, Canada.
  • Buck BH; Department of Medicine, University of Ottawa and University of Ottawa Heart Institute, Ottawa, ON, Canada.
  • Swartz RH; Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
  • Sajobi TT; London Health Sciences Centre and Western University, London, ON, Canada.
  • Almekhlafi M; Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.
  • Demchuk AM; Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
  • Ganesh A; Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
  • Menon B; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
  • Singh N; Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Int J Stroke ; : 17474930241273561, 2024 Sep 11.
Article en En | MEDLINE | ID: mdl-39086232
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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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Stroke Año: 2024 Tipo del documento: Article País de afiliación: Canadá
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Int J Stroke Año: 2024 Tipo del documento: Article País de afiliación: Canadá