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Twenty-Four-Hour Post-Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study.
You, Shoujiang; Wang, Yanan; Wang, Xia; Maeda, Toshiki; Ouyang, Menglu; Han, Qiao; Li, Qiang; Song, Lili; Zhao, Yang; Chen, Chen; Delcourt, Candice; Ren, Xinwen; Carcel, Cheryl; Zhou, Zien; Cao, Yongjun; Liu, Chun-Feng; Zheng, Danni; Arima, Hisatomi; Robinson, Thompson G; Chen, Xiaoying; Lindley, Richard I; Chalmers, John; Anderson, Craig S.
Afiliación
  • You S; Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou China.
  • Wang Y; Department of Neurology, West China Hospital Sichuan University Chengdu Sichuan China.
  • Wang X; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Maeda T; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Ouyang M; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Han Q; Department of Preventive Medicine and Public Health Fukuoka University Fukuoka Japan.
  • Li Q; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Song L; Department of Neurology Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine Suzhou China.
  • Zhao Y; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Chen C; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Delcourt C; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Ren X; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Carcel C; Department of Neurology, Shanghai East Hospital, School of Medicine Tongji University Shanghai China.
  • Zhou Z; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Cao Y; Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences Macquarie University Sydney NSW Australia.
  • Liu CF; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Zheng D; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Arima H; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Robinson TG; Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou China.
  • Chen X; Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou China.
  • Lindley RI; The George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW Australia.
  • Chalmers J; Department of Preventive Medicine and Public Health Fukuoka University Fukuoka Japan.
  • Anderson CS; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of Leicester Leicester UK.
J Am Heart Assoc ; 13(18): e036109, 2024 Sep 17.
Article en En | MEDLINE | ID: mdl-39258531
ABSTRACT

BACKGROUND:

This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). METHODS AND

RESULTS:

ENCHANTED was an international, multicenter, 2×2 quasifactorial, prospective, randomized open trial of low-dose versus standard-dose intravenous alteplase and intensive versus guideline-recommended blood pressure lowering in thrombolysis-eligible patients with acute ischemic stroke. Absolute (baseline minus 24 hours) and percentage (absolute change/baseline × 100) changes in NIHSS scores were calculated. Receiver operating characteristic curve analyses assessed performance of different NIHSS measurements on 90-day favorable functional recovery (modified Rankin Scale [mRS] score 0-2) and excellent functional recovery (mRS score 0-1). Youden index was used to identify optimal predictor cutoff points. A total of 4410 patients in the ENCHANTED trial were enrolled. The 24-hour NIHSS score had the highest discriminative ability for predicting favorable 90-day functional recovery (mRS score 0-2; area under the curve 0.866 versus 0.755, 0.689, 0.764; P<0.001) than baseline, absolute, and percentage change of NIHSS score, respectively. The optimal cutoff point of 24-hour NIHSS score for predicting favorable functional recovery was ≤4 (sensitivity 66.5%, specificity 87.1%, adjusted odds ratio, 9.44 [95% CI, 7.77-11.48]). The 24-hour NIHSS score (≤3) was the best predictor of 90-day excellent functional recovery (mRS score 0-1). Findings were consistent across subgroups, including sex, race, baseline NIHSS score, stroke subtype, and age.

CONCLUSIONS:

In thrombolysis-eligible patients with acute ischemic stroke, 24-hour NIHSS score (optimal cutpoint of 4) is the strongest predictor of 90-day functional recovery over baseline and early change of NIHSS score. REGISTRATION URL https//clinicaltrials.gov. Unique Identifier NCT01422616.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Activador de Tejido Plasminógeno / Recuperación de la Función / Fibrinolíticos / Accidente Cerebrovascular Isquémico Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Activador de Tejido Plasminógeno / Recuperación de la Función / Fibrinolíticos / Accidente Cerebrovascular Isquémico Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Heart Assoc Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido