- Title
- Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis
- Creator
- Katsanos, A. H.; Alexandrov, A. V.; Grotta, J. C.; Levi, C. R.; Molina, C. A.; Saqqur, M.; Palaiodimou, L.; Psaltopoulou, T.; Vosko, M. R.; Moreira, T.; Fiebach, J. B.; Rubiera, M.; Mandava, P.; Sandset, EC; de Havenon, A; Kent, TA; Alexandrov, AW; Schellinger, PD; Tsivgoulis, G; Köhrmann, M.; Soinne, L.; Barreto, A. D.; Sharma, V. K.; Mikulik, R.; Muir, K. W.; Rothlisberger, T.
- Relation
- European Journal of Neurology Vol. 27, Issue 12, p. 2453-2462
- Publisher Link
- http://dx.doi.org/10.1111/ene.14447
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2020
- Description
- Background and purpose: Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. Methods: Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AIS patients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. Results: Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P < 0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P = 0.011) and 90-day mortality (P < 0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52–0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23–2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36 h after IVT administration. Conclusions: Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AIS patients treated with IVT.
- Subject
- blood pressure; intracranial hemorrhage; outcome; pulse pressure; sonothrombolysis; stroke; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1444331
- Identifier
- uon:42269
- Identifier
- ISSN:1351-5101
- Rights
- This is the peer reviewed version of the following article: Katsanos, A. H.; Alexandrov, A. V.; Grotta, J. C.; Levi, C. R.; Molina, C. A.; Saqqur, M.; Palaiodimou, L.; Psaltopoulou, T.; Vosko, M. R.; Moreira, T.; Fiebach, J. B.; Rubiera, M.; Mandava, P.; Sandset, EC; de Havenon, A; Kent, TA; Alexandrov, AW; Schellinger, PD; Tsivgoulis, G; Köhrmann, M.; Soinne, L.; Barreto, A. D.; Sharma, V. K.; Mikulik, R.; Muir, K. W.; Rothlisberger, T. “Pulse pressure variability is associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis”. European Journal of Neurology Vol. 27, Issue 12, p. 2453-2462 (2020), which has been published in final form at http://dx.doi.org/10.1111/ene.14447. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
- Language
- eng
- Full Text
- Reviewed
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