Caty Carrera1, Natalia Cullell1, Nuria Torres-Águila1, Elena Muiño1, Alejandro Bustamante1, Antonio Dávalos1, Elena López-Cancio1, Marc Ribó1, Carlos A Molina1, Eva Giralt-Steinhauer1, Carolina Soriano-Tárraga1, Marina Mola-Caminal1, Jordi Jiménez-Conde1, Jaume Roquer1, Cristófol Vives-Bauza1, Rosa Díaz Navarro1, Victor Obach1, Juan Francisco Arenillas1, Tomás Segura1, Gemma Serrano-Heras1, Joan Martí-Fàbregas1, Marimar Freijo1, Juan Antonio Cabezas1, Turgut Tatlisumak1, Laura Heitsch1, Laura Ibañez1, Carlos Cruchaga1, Jin-Moo Lee1, Daniel Strbian1, Joan Montaner1, Israel Fernández-Cadenas2. 1. From the Neurovascular Research Laboratory (C.C., A.B.), Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona; Stroke Pharmacogenomics and Genetics (N.C., N.-T.A.) and Stroke Genomics and Genetics (E.M.), Fundació Docència i Recerca Mútua Terrassa; Department of Neuroscience (A.D.), Hospital Germans Trias i Pujol; Stroke Unit (E.L.-C.), Hospital Universitario Central de Asturias; Stroke Unit (M.R., C.A.M.), Hospital Universitari Vall d'Hebron; Stroke Unit, Hospital Universitari Vall d'Hebron; Department of Neurology (E.G.-S., C.S.-T., M.M.-C., J.J.-C., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar; Neurobiology Laboratory (C.V.-B.), Institut d'Investigacio Sanitaria de Palma; Department of Neurology (R.D.N.), Hospital Universitari Son Espases; Department of Neurology (V.O.), Hospital Clínic i Provincial de Barcelona; Department of Neurology (J.F.A.), Hospital Clínico Universitario, University of Valladolid; Department of Neurology (T.S.) and Experimental Research Unit (G.S.-H.), Hospital Universitario de Albacete; Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau; Department of Neurology (M.F.), Hospital de Basurto; Department of Neurology (J.A.C.), Virgen del Rocío & Macarena Hospitals, IBIS, Spain; Department of Clinical Neuroscience/Neurology (T.T.), Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Sweden; Division of Emergency Medicine (L.H.), Department of Psychiatry (L.I., C.C.), and Department of Neurology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; Department of Neurology (D.S.), Helsinki University Hospital, Finland; Department of Neurology (J.M.), Virgen del Rocío & Macarena Hospitals, IBIS. Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona; and Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mútua Terrassa, Hospital Universitari Mútua de Terrassa, Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Spain. 2. From the Neurovascular Research Laboratory (C.C., A.B.), Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona; Stroke Pharmacogenomics and Genetics (N.C., N.-T.A.) and Stroke Genomics and Genetics (E.M.), Fundació Docència i Recerca Mútua Terrassa; Department of Neuroscience (A.D.), Hospital Germans Trias i Pujol; Stroke Unit (E.L.-C.), Hospital Universitario Central de Asturias; Stroke Unit (M.R., C.A.M.), Hospital Universitari Vall d'Hebron; Stroke Unit, Hospital Universitari Vall d'Hebron; Department of Neurology (E.G.-S., C.S.-T., M.M.-C., J.J.-C., J.R.), Neurovascular Research Group, IMIM-Hospital del Mar; Neurobiology Laboratory (C.V.-B.), Institut d'Investigacio Sanitaria de Palma; Department of Neurology (R.D.N.), Hospital Universitari Son Espases; Department of Neurology (V.O.), Hospital Clínic i Provincial de Barcelona; Department of Neurology (J.F.A.), Hospital Clínico Universitario, University of Valladolid; Department of Neurology (T.S.) and Experimental Research Unit (G.S.-H.), Hospital Universitario de Albacete; Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau; Department of Neurology (M.F.), Hospital de Basurto; Department of Neurology (J.A.C.), Virgen del Rocío & Macarena Hospitals, IBIS, Spain; Department of Clinical Neuroscience/Neurology (T.T.), Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Sweden; Division of Emergency Medicine (L.H.), Department of Psychiatry (L.I., C.C.), and Department of Neurology (J.-M.L.), Washington University School of Medicine, St. Louis, MO; Department of Neurology (D.S.), Helsinki University Hospital, Finland; Department of Neurology (J.M.), Virgen del Rocío & Macarena Hospitals, IBIS. Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona; and Stroke Pharmacogenomics and Genetics (I.F.-C.), Fundació Docència i Recerca Mútua Terrassa, Hospital Universitari Mútua de Terrassa, Stroke Pharmacogenomics and Genetics, IIB-Sant Pau, Spain. israelcadenas@yahoo.es.
Abstract
OBJECTIVE: To validate the Genot-PA score, a clinical-genetic logistic regression score that stratifies the thrombolytic therapy safety, in a new cohort of patients with stroke. METHODS: We enrolled 1,482 recombinant tissue plasminogen activator (rtPA)-treated patients with stroke in Spain and Finland from 2003 to 2016. Cohorts were analyzed on the basis of ethnicity and therapy: Spanish patients treated with IV rtPA within 4.5 hours of onset (cohort A and B) or rtPA in combination with mechanical thrombectomy within 6 hours of onset (cohort C) and Finnish participants treated with IV rtPA within 4.5 hours of onset (cohort D). The Genot-PA score was calculated, and hemorrhagic transformation (HT) and parenchymal hematoma (PH) risks were determined for each score stratum. RESULTS: Genot-PA score was tested in 1,324 (cohort A, n = 726; B, n = 334; C, n = 54; and D, n = 210) patients who had enough information to complete the score. Of these, 213 (16.1%) participants developed HT and 85 (6.4%) developed PH. In cohorts A, B, and D, HT occurrence was predicted by the score (p = 2.02 × 10-6, p = 0.023, p = 0.033); PH prediction was associated in cohorts A through C (p = 0.012, p = 0.034, p = 5.32 × 10-4). Increased frequency of PH events from the lowest to the highest risk group was found (cohort A 4%-15.7%, cohort B 1.5%-18.2%, cohort C 0%-100%). The best odds ratio for PH prediction in the highest-risk group was obtained in cohort A (odds ratio 5.16, 95% confidence interval 1.46-18.08, p = 0.009). CONCLUSION: The Genot-PA score predicts HT in patients with stroke treated with IV rtPA. Moreover, in an exploratory study, the score was associated with PH risk in mechanical thrombectomy-treated patients.
OBJECTIVE: To validate the Genot-PA score, a clinical-genetic logistic regression score that stratifies the thrombolytic therapy safety, in a new cohort of patients with stroke. METHODS: We enrolled 1,482 recombinant tissue plasminogen activator (rtPA)-treated patients with stroke in Spain and Finland from 2003 to 2016. Cohorts were analyzed on the basis of ethnicity and therapy: Spanish patients treated with IV rtPA within 4.5 hours of onset (cohort A and B) or rtPA in combination with mechanical thrombectomy within 6 hours of onset (cohort C) and Finnish participants treated with IV rtPA within 4.5 hours of onset (cohort D). The Genot-PA score was calculated, and hemorrhagic transformation (HT) and parenchymal hematoma (PH) risks were determined for each score stratum. RESULTS: Genot-PA score was tested in 1,324 (cohort A, n = 726; B, n = 334; C, n = 54; and D, n = 210) patients who had enough information to complete the score. Of these, 213 (16.1%) participants developed HT and 85 (6.4%) developed PH. In cohorts A, B, and D, HT occurrence was predicted by the score (p = 2.02 × 10-6, p = 0.023, p = 0.033); PH prediction was associated in cohorts A through C (p = 0.012, p = 0.034, p = 5.32 × 10-4). Increased frequency of PH events from the lowest to the highest risk group was found (cohort A 4%-15.7%, cohort B 1.5%-18.2%, cohort C 0%-100%). The best odds ratio for PH prediction in the highest-risk group was obtained in cohort A (odds ratio 5.16, 95% confidence interval 1.46-18.08, p = 0.009). CONCLUSION: The Genot-PA score predicts HT in patients with stroke treated with IV rtPA. Moreover, in an exploratory study, the score was associated with PH risk in mechanical thrombectomy-treated patients.
Authors: Bijoy K Menon; Jeffrey L Saver; Shyam Prabhakaran; Mathew Reeves; Li Liang; Daiwai M Olson; Eric D Peterson; Adrian F Hernandez; Gregg C Fonarow; Lee H Schwamm; Eric E Smith Journal: Stroke Date: 2012-07-17 Impact factor: 7.914
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Authors: Mar Castellanos; Rogelio Leira; Joaquín Serena; Miguel Blanco; Salvador Pedraza; José Castillo; Antoni Dávalos Journal: Stroke Date: 2004-05-27 Impact factor: 7.914
Authors: Arne G Lindgren; Robynne G Braun; Jennifer Juhl Majersik; Philip Clatworthy; Shraddha Mainali; Colin P Derdeyn; Jane Maguire; Christina Jern; Jonathan Rosand; John W Cole; Jin-Moo Lee; Pooja Khatri; Paul Nyquist; Stéphanie Debette; Loo Keat Wei; Tatjana Rundek; Dana Leifer; Vincent Thijs; Robin Lemmens; Laura Heitsch; Kameshwar Prasad; Jordi Jimenez Conde; Martin Dichgans; Natalia S Rost; Steven C Cramer; Julie Bernhardt; Bradford B Worrall; Israel Fernandez-Cadenas Journal: Int J Stroke Date: 2021-04-26 Impact factor: 5.266