Effect of baseline infarct size on endovascular thrombectomy with or without intravenous alteplase in stroke patients: A subgroup analysis of a randomized trial (DIRECT‐MT)

医学 改良兰金量表 置信区间 析因分析 优势比 冲程(发动机) 子群分析 随机对照试验 临床终点 内科学 溶栓 麻醉 缺血性中风 心肌梗塞 缺血 工程类 机械工程
作者
Zhenyu Jia,Yong Xin Zhang,Yue Cao,Lin Zhao,Hai Bin Shi,Lei Zhang,Zi Fu Li,Hong Shen,Min Lou,Yong‐Wei Zhang,Guo Yin,Xiao Fei Ye,Peng Yang,Sheng Liu,Jian Min Liu
出处
期刊:European Journal of Neurology [Wiley]
卷期号:29 (6): 1643-1651 被引量:11
标识
DOI:10.1111/ene.15276
摘要

Abstract Background and purpose DIRECT‐MT showed that endovascular thrombectomy was noninferior to thrombectomy preceded by intravenous alteplase with regard to functional outcome in patients with acute ischemic stroke. In this post hoc analysis, we examined whether infarct size modified the effect of alteplase. Methods All patients with baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) grades were included. The primary outcome was the 90‐day modified Rankin Scale (mRS) score. Multivariate ordinal logistic regression analysis was used to calculate the adjusted common odds ratio (OR) for better functional outcome based on the mRS for thrombectomy alone versus combination therapy. An interaction term was entered to test for an interaction with baseline ASPECTS subgroups: 0–4 versus 5–7 versus 8–10. Results Of 649 patients, 323 (49.8%) were in the thrombectomy‐alone group and 326 (50.2%) in the combination‐therapy group. There was no significant treatment‐by‐trichotomized ASPECTS interaction with alteplase prior to endovascular treatment for the primary endpoint of ordinal mRS ( p ‐value interaction term relative to ASPECTS 8–10: ASPECTS 0–4, p = 0.386; ASPECTS 5–7, p = 0.936). Adjusted common ORs for improvement in the 90‐day mRS with thrombectomy alone compared with combination therapy were 1.99 (95% confidence interval = 0.72–5.46) for ASPECTS 0–4, 1.07 (0.62–1.86) for ASPECTS 5–7, and 1.03 (0.74–1.45) for ASPECTS 8–10. There was no significant difference in the safety outcomes between the two groups. Conclusions Baseline infarct size may not modify the effect of alteplase prior to endovascular thrombectomy with regard to favorable functional outcomes and adverse events.
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