Abstract Details

Title Impact of Early Neurologic Deterioration on 90 Day Stroke Outcomes after Thrombolytic Therapy for Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 228

Objective

Background BACKGROUND: Recent definitions of symptomatic ICH after thrombolysis (e.g. ECASS 2) have included assessment of END, defined by worsening of ?4 on the 24 hour NIHSS. However, the degree of END making the greatest impact on final outcome is undefined.

Design/Methods DESIGN/METHODS: Using the NINDS TPA Trials, we examined subjects in the tPA group who had END without ICH vs. those with ICH, comparing them to subjects who had ICH and END, and ICH patients without END. Using a 16-variable prognostic ordinal logistic model derived from the placebo group, we compared the actual 90 day mRS for these groups to their model-predicted mRS had they not received TPA.

Results RESULTS: Among the 624 subjects in the trials, 55 (17.6%) placebo and 43 (13.7%) tPA subjects developed END (p=0.38). The relationship was approximately linear between 90 day mRS and change in 24 hr NIHSS score in both the TPA and placebo groups, with Spearman correlation coefficients of -0.51 and -0.37 (r-square 0.24 and 0.15), respectively (p=0.031 difference). When comparing TPA subjects with END to those without END, the mean mRS was 4.86 vs. 2.37(p=0.001, Wilcoxon rank sum test) respectively. Of all subjects with END, the mean 90 day mRS was 5.83 with ICH and 4.48 (p=0.009) w/o ICH. When compared to the prognostic model, there was a larger difference between observed and predicted mean mRS between those with ICH who had END and those that did not (2.24 vs. 0.03, p=0.004) compared to subjects with END who had ICH and those without ICH (2.27 vs. 1.36, p=0.09).

Conclusions CONCLUSIONS: END has a significant impact on 90 day mRS. The relationship between END and 90 day outcome is nearly linear. ICH with END confers worse prognosis than END alone.

Authors/Disclosures
Neal M. Rao, MD (UCLA Stroke Center) PRESENTER	Dr. Rao has nothing to disclose.
	No disclosure on file
Steven Levine, MD, FAHA (SUNY Downstate Medical Center)	Dr. Levine has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for MEDLINK. Dr. Levine has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Law Firms. The institution of Dr. Levine has received research support from NIH.
Jeffrey L. Saver, MD, FAAN (UCLA Health)	Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim (prevention only). Dr. Saver has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. Dr. Saver has received stock or an ownership interest from Rapid Medical.
	No disclosure on file

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