OBJECTIVES: Age and stroke severity are major determinants of stroke outcomes, but systematically incorporating these prognosticators in the routine practice of acute ischemic stroke can be challenging. We evaluated the effect of an index combining age and stroke severity on response to IV tissue plasminogen activator (tPA) among patients in the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials. METHODS: We created the Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index by combining age in years plus NIH Stroke Scale (NIHSS) ≥100. We applied the SPAN-100 index to patients in the NINDS tPA stroke trials (parts I and II) to evaluate its ability to predict clinical response and risk of intracerebral hemorrhage (ICH) after thrombolysis. The main outcome measures included ICH (any type) and a composite favorable outcome (defined as a modified Rankin Scale score of 0 or 1, NIHSS ≤1, Barthel index ≥95, and Glasgow Outcome Scale score of 1) at 3 months. Bivariate and multivariable logistic regression analyses were used to determine the association between SPAN-100 and outcomes of interest. RESULTS: Among 624 patients in the NINDS trials, 62 (9.9%) participants were SPAN-100 positive. Among those receiving tPA, ICH rates were higher for SPAN-100-positive patients (42% vs 12% in SPAN-100-negative patients; p < 0.001); similarly, ICH rates were higher in SPAN-100-positive patients (19% vs 5%; p = 0.005) among those not receiving tPA. SPAN-100 was associated with worse outcomes. The benefit of tPA, defined as favorable composite outcome at 3 months, was present in SPAN-100-negative patients (55.4% vs 40.2%; p < 0.001), but not in SPAN-100-positive patients (5.6% tPA vs 3.9%; p = 0.76). Similar trends were found for secondary outcomes (e.g., symptomatic ICH, catastrophic outcome, discharge home). CONCLUSION: The SPAN-100 index could be a simple method for estimating the clinical response and risk of hemorrhagic complications after tPA for acute ischemic stroke. These results need further confirmation in larger contemporary datasets.
RCT Entities:
OBJECTIVES: Age and stroke severity are major determinants of stroke outcomes, but systematically incorporating these prognosticators in the routine practice of acute ischemic stroke can be challenging. We evaluated the effect of an index combining age and stroke severity on response to IV tissue plasminogen activator (tPA) among patients in the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke trials. METHODS: We created the Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index by combining age in years plus NIH Stroke Scale (NIHSS) ≥100. We applied the SPAN-100 index to patients in the NINDS tPA stroke trials (parts I and II) to evaluate its ability to predict clinical response and risk of intracerebral hemorrhage (ICH) after thrombolysis. The main outcome measures included ICH (any type) and a composite favorable outcome (defined as a modified Rankin Scale score of 0 or 1, NIHSS ≤1, Barthel index ≥95, and Glasgow Outcome Scale score of 1) at 3 months. Bivariate and multivariable logistic regression analyses were used to determine the association between SPAN-100 and outcomes of interest. RESULTS: Among 624 patients in the NINDS trials, 62 (9.9%) participants were SPAN-100 positive. Among those receiving tPA, ICH rates were higher for SPAN-100-positive patients (42% vs 12% in SPAN-100-negative patients; p < 0.001); similarly, ICH rates were higher in SPAN-100-positive patients (19% vs 5%; p = 0.005) among those not receiving tPA. SPAN-100 was associated with worse outcomes. The benefit of tPA, defined as favorable composite outcome at 3 months, was present in SPAN-100-negative patients (55.4% vs 40.2%; p < 0.001), but not in SPAN-100-positive patients (5.6% tPA vs 3.9%; p = 0.76). Similar trends were found for secondary outcomes (e.g., symptomatic ICH, catastrophic outcome, discharge home). CONCLUSION: The SPAN-100 index could be a simple method for estimating the clinical response and risk of hemorrhagic complications after tPA for acute ischemic stroke. These results need further confirmation in larger contemporary datasets.
Authors: Gustavo Saposnik; Jiming Fang; Moira K Kapral; Jack V Tu; Muhammad Mamdani; Peter Austin; S Claiborne Johnston Journal: Stroke Date: 2012-02-03 Impact factor: 7.914
Authors: D Strbian; A Meretoja; F J Ahlhelm; J Pitkäniemi; P Lyrer; M Kaste; S Engelter; T Tatlisumak Journal: Neurology Date: 2012-02-07 Impact factor: 9.910
Authors: Gustavo Saposnik; Stavroula Raptis; Moira K Kapral; Ying Liu; Jack V Tu; Muhammad Mamdani; Peter C Austin Journal: Stroke Date: 2011-09-29 Impact factor: 7.914
Authors: Gustavo Saposnik; Moira K Kapral; Ying Liu; Ruth Hall; Martin O'Donnell; Stavroula Raptis; Jack V Tu; Muhammad Mamdani; Peter C Austin Journal: Circulation Date: 2011-02-07 Impact factor: 29.690
Authors: Werner Hacke; Markku Kaste; Erich Bluhmki; Miroslav Brozman; Antoni Dávalos; Donata Guidetti; Vincent Larrue; Kennedy R Lees; Zakaria Medeghri; Thomas Machnig; Dietmar Schneider; Rüdiger von Kummer; Nils Wahlgren; Danilo Toni Journal: N Engl J Med Date: 2008-09-25 Impact factor: 91.245
Authors: Inke R König; Andreas Ziegler; Erich Bluhmki; Werner Hacke; Philip M W Bath; Ralph L Sacco; Hans C Diener; Christian Weimar Journal: Stroke Date: 2008-04-10 Impact factor: 7.914
Authors: Nishant K Mishra; Niaz Ahmed; Grethe Andersen; José A Egido; Perttu J Lindsberg; Peter A Ringleb; Nils G Wahlgren; Kennedy R Lees Journal: BMJ Date: 2010-11-23
Authors: David Asuzu; Karin Nyström; Joseph Schindler; Charles Wira; David Greer; Janet Halliday; Kevin N Sheth Journal: Neurocrit Care Date: 2015-10 Impact factor: 3.210
Authors: Alexander C Flint; Sean P Cullen; Vivek A Rao; Bonnie S Faigeles; Vitor M Pereira; Elad I Levy; Tudor G Jovin; David S Liebeskind; Raul G Nogueira; Reza Jahan; Jeffrey L Saver Journal: Int J Stroke Date: 2014-05-20 Impact factor: 5.266
Authors: David M Kent; Robin Ruthazer; Carole Decker; Philip G Jones; Jeffrey L Saver; Erich Bluhmki; John A Spertus Journal: Neurology Date: 2015-08-19 Impact factor: 9.910
Authors: Joshua A Stone; Joshua Z Willey; Salah Keyrouz; James Butera; Ryan A McTaggart; Shawna Cutting; Brian Silver; Bradford Thompson; Karen L Furie; Shadi Yaghi Journal: Curr Treat Options Neurol Date: 2017-01 Impact factor: 3.598
Authors: David Asuzu; Karin Nyström; Hardik Amin; Joseph Schindler; Charles Wira; David Greer; Nai Fang Chi; Janet Halliday; Kevin N Sheth Journal: Neurocrit Care Date: 2015-10 Impact factor: 3.210
Authors: Alexander C Flint; Bin Xiang; Rishi Gupta; Raul G Nogueira; Helmi L Lutsep; Tudor G Jovin; Gregory W Albers; David S Liebeskind; Nerses Sanossian; Wade S Smith Journal: Stroke Date: 2013-09-26 Impact factor: 7.914
Authors: M A Almekhlafi; A Davalos; A Bonafe; R Chapot; J Gralla; V M Pereira; M Goyal Journal: AJNR Am J Neuroradiol Date: 2014-02-20 Impact factor: 3.825