Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Alain Duhamel¹  Julien Labreuche¹  Guillaume Taylor²  Anne Claire Lukaszewicz³  Michel Piotin⁴  Stanislas Smajda⁴  Raphaël Blanc⁴  Benjamin Maïer⁴  Gabriele Ciccio⁴  Mikael Mazighi⁴  Marie Abrivard⁴  Hocine Redjem⁴  Jean‐Philippe Desilles⁴  Michael Obadia⁵  Bertrand Lapergue⁶  Paul Emile Labeyrie⁷  Francis Turjman⁷  Roberto Riva⁷  Benjamin Gory⁷  Jacques Blacher⁸ 

[1] Department of Biostatistics, Université de Lille, CHU Lille, EA 2694—Santé publique: Epidémiologie et Qualité des Soins, Lille, France;Department of Intensive Care Unit, Fondation Rothschild, Paris, France;Department of Intensive Care Unit, Hospices Civils de Lyon, Hôpital Pierre Wertheimer Lyon, France;Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France;Department of Neurology, Division of Neurology, Fondation Rothschild, Paris, France;Department of Neurology, Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint‐Quentin en Yvelines, Suresnes, France;FHU IRIS, Department of Interventional Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France;Hypertension Unit, Cardiovascular Prevention and Therapeutic Center Hôtel‐Dieu, Paris, France;

关键词: blood pressure;    ischemic;    stroke;    stroke management;    thrombectomy;   

DOI  :  10.1161/JAHA.117.006484

来源: DOAJ

【 摘 要 】

BackgroundHigh blood pressure (BP) is associated with worse clinical outcomes in the setting of acute ischemic stroke, but the optimal blood pressure target is still a matter of debate. We aimed to study the association between baseline BP and mortality in acute ischemic stroke patients treated by mechanical thrombectomy. Methods and ResultsA total of 1332 acute ischemic stroke patients treated by mechanical thrombectomy were enrolled (from January 2012 to June 2016) in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Linear and polynomial logistic regression models were used to assess the association between BP and mortality and functional outcome at 90 days. Highest mortality was found at lower and higher baseline systolic blood pressure (SBP) values following a J‐ or U‐shaped relationship, with a nadir at 157 mm Hg (95% confidence interval 143‐170). When SBP values were categorized in 10–mm Hg increments, the odds ratio for all‐cause mortality was 3.78 (95% confidence interval 1.50‐9.55) for SBP<110 mm Hg and 1.81 (95% confidence interval 1.01‐3.36) for SBP≥180 mm Hg using SBP≥150 to 160 mm Hg as reference. The rate of favorable outcome was the highest at low SBP values and lowest at high SBP values, with a nonlinear relationship; in unplanned exploratory analysis, an optimal threshold SBP≥177 mm Hg was found to predict unfavorable outcome (adjusted odds ratio 0.47; 95% confidence interval 0.31‐0.70). ConclusionIn acute ischemic stroke patients treated by mechanical thrombectomy, baseline SBP is associated with all‐cause mortality and favorable outcome. In contrast to mortality, favorable outcome rate was the highest at low SBP values and lowest at high SBP values. Further studies are warranted to confirm these findings.

【 授权许可】

Unknown