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Multicenter Study
. 2019 Dec;50(12):3449-3455.
doi: 10.1161/STROKEAHA.119.026889. Epub 2019 Oct 7.

Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST): A Multicenter Prospective Cohort Study

Eva A Mistry  1 , Heidi Sucharew  2 , Akshitkumar M Mistry  3 , Tapan Mehta  4 , Niraj Arora  5 , Amy K Starosciak  6 , Felipe De Los Rios La Rosa  6 , James Ernest Siegler 3rd  7 , Natasha R Barnhill  8 , Kishan Patel  9 , Salman Assad  10 , Amjad Tarboosh  10 , Katarina Dakay  11 , Sanjana Salwi  12 , Aurora S Cruz  13 , Jeffrey Wagner  14 , Enzo Fortuny  13 , Alicia Bennett  14 , Robert F James  13 , Bharathi Jagadeesan  4 , Christopher Streib  4 , Kristine O'Phelan  5 , Scott E Kasner  7 , Stewart A Weber  8 , Rohan Chitale  3 , John J Volpi  9 , Stephan Mayer  10 , Shadi Yaghi  15 , Mahesh V Jayaraman  11 , Pooja Khatri  16
Affiliations
Multicenter Study

Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST): A Multicenter Prospective Cohort Study

Eva A Mistry et al. Stroke. 2019 Dec.

Abstract

Background and Purpose- To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure (SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mm Hg), we conducted a prospective, multicenter, cohort study with a prespecified analysis plan. Methods- Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017 to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVT were recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized 90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomes was quantified using multiple logistic regression. Results- Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBP of 158 mm Hg was associated with the largest difference in the dichotomous modified Rankin Scale score (absolute risk reduction of 19%). Having a peak SBP >158 mm Hg resulted in an increased likelihood of modified Rankin Scale score 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment for prespecified variables). Conclusions- A peak post-EVT SBP of 158 mm Hg was prospectively identified to best discriminate good from bad functional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, but not in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testing in a future randomized trial of goal-targeted post-EVT antihypertensive treatment.

Keywords: antihypertensive agents; blood pressure; brain ischemia; reperfusion; retrospective studies.

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Figures

Figure 1.
Figure 1.. Distributions of 90-day Modified Rankin Scores.
Distribution in patients with a peak systolic blood pressure of ≤158 mmHg and >158 mmHg in the initial 24 hours after endovascular stroke therapy for an anterior large cerebral vessel occlusion.
Figure 2.
Figure 2.. Subgroup analysis for heterogeneity of effect of peak systolic blood pressure >158 mmHg on 90-day Modified Rankin Score 3-6.
The odds of having a modified Rankin Score of 3-6 for each subgroup is depicted with a square and a line spanning it representing a 95% confidence interval on the forest plot on the right.
Figure 3.
Figure 3.. Time-dependent changes in the systolic blood pressure according to the 90-day patient outcome.
Lines with a ribbon represent a generalized additive model (mean-like) fitted to all (17,850) SBP values recorded over 24 hours with 95% confidence interval.
See this image and copyright information in PMC

Comment in

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