Abstract Details

Title Is Arrival Blood Pressure Indicative of Stroke Type To Optimize Premixing tPA? An Analysis of Two National Institute of Neurological Disorders And Stroke Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-009

Objective To determine whether arrival blood pressure (BP) can differentiate stroke type and to determine an optimal BP cut-off to aid in pre-mixing tPA.

Background Most patients with acute neurological events present hypertensive. It is unknown whether BP can aid in differentiating stroke type: acute ischemic stroke (AIS) or primary intracerebral hemorrhage (PICH). If BP is indicative, management could be expedited before confirmatory neuroimaging, such as pre-mixing IV tPA and lowering elevated blood pressure.

Design/Methods Our study population was selected from two NINDS clinical trials that did not use blood pressure as a selection criterion: ALIAS 1 trial (AIS, n=434) and ERICH trial (PICH, n=3,000). Multivariate logistic regression and t-tests were used to analyze the first recorded BP (systolic: SBP; diastolic: DBP) for patients with AIS vs. PICH. Receiver operator characteristic (ROC) curves were used to determine an optimal BP cutoff for ruling out PICH and pre-mixing tPA (specificity) and conversely for correctly identifying AIS (sensitivity).

Results Compared to AIS, patients with PICH had significantly higher mean SBP (186 vs. 158, p<0.001) and DBP (103 vs. 84, p<0.001). Compared to AIS, there was 23% increased odds of PICH for each 10-unit increase in SBP (p<0.001) and 35% increased odds of PICH for each 10-unit increase in DBP (p<0.001), after adjustment for age, gender, race/ethnicity, and history of hypertension. The AUROC was 0.70, with 95% specificity for ruling out ICH (5% tPA wastage) using cutoffs of SBP <127 and DBP <80. Conversely, 95% sensitivity for identifying AIS resulted in cutoffs of SBP <211 and DBP <130, corresponding to 5% of AIS patients with a delay in tPA for not pre-mixing.

Conclusions Although our study demonstrated arrival blood pressure was significantly associated with stroke type, the significant overlap and moderate AUROC suggest BP is not indicative and sufficiently dichotomous to delay pre-mixing tPA.

Authors/Disclosures
Russell E. Bartt, MD, FAAN (Blue Sky Neurosciences) PRESENTER	Dr. Bartt has nothing to disclose.
Kristin Salottolo, MPH	Ms. Salottolo has nothing to disclose.
Ann Wyborny, DO	No disclosure on file
	No disclosure on file
David Bar-Or	David Bar-Or has received intellectual property interests from a discovery or technology relating to health care.

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