RT Journal Article
T1 Early Neurological Change After Ischemic Stroke Is Associated With 90-Day Outcome.
A1 Heitsch, Laura
A1 Ibanez, Laura
A1 Carrera, Caty
A1 Binkley, Michael M
A1 Strbian, Daniel
A1 Tatlisumak, Turgut
A1 Bustamante, Alejandro
A1 Ribó, Marc
A1 Molina, Carlos
A1 Dávalos, Antoni
A1 López-Cancio, Elena
A1 Muñoz-Narbona, Lucia
A1 Soriano-Tárraga, Carol
A1 Giralt-Steinhauer, Eva
A1 Obach, Victor
A1 Slowik, Agnieszka
A1 Pera, Joanna
A1 Lapicka-Bodzioch, Katarzyna
A1 Derbisz, Justyna
A1 Sobrino, Tomás
A1 Castillo, José
A1 Campos, Francisco
A1 Rodríguez-Castro, Emilio
A1 Arias-Rivas, Susana
A1 Segura, Tomas
A1 Serrano-Heras, Gemma
A1 Vives-Bauza, Cristófol
A1 Díaz-Navarro, Rosa
A1 Tur, Silva
A1 Jimenez, Carmen
A1 Martí-Fàbregas, Joan
A1 Delgado-Mederos, Raquel
A1 Arenillas, Juan
A1 Krupinski, Jerzy
A1 Cullell, Natalia
A1 Torres-Aguila, Nuria P
A1 Muiño, Elena
A1 Cárcel-Márquez, Jara
A1 Moniche, Francisco
A1 Cabezas, Juan A
A1 Ford, Andria L
A1 Dhar, Rajat
A1 Roquer, Jaume
A1 Khatri, Pooja
A1 Jiménez-Conde, Jordi
A1 Fernandez-Cadenas, Israel
A1 Montaner, Joan
A1 Rosand, Jonathan
A1 Cruchaga, Carlos
A1 Lee, Jin-Moo
A1 International Stroke Genetics Consortium, 
K1 genome-wide association study
K1 phenotype
K1 population
K1 stroke, ischemic
AB Large-scale observational studies of acute ischemic stroke (AIS) promise to reveal mechanisms underlying cerebral ischemia. However, meaningful quantitative phenotypes attainable in large patient populations are needed. We characterize a dynamic metric of AIS instability, defined by change in National Institutes of Health Stroke Scale score (NIHSS) from baseline to 24 hours baseline to 24 hours (NIHSSbaseline - NIHSS24hours = ΔNIHSS6-24h), to examine its relevance to AIS mechanisms and long-term outcomes. Patients with NIHSS prospectively recorded within 6 hours after onset and then 24 hours later were enrolled in the GENISIS study (Genetics of Early Neurological Instability After Ischemic Stroke). Stepwise linear regression determined variables that independently influenced ΔNIHSS6-24h. In a subcohort of tPA (alteplase)-treated patients with large vessel occlusion, the influence of early sustained recanalization and hemorrhagic transformation on ΔNIHSS6-24h was examined. Finally, the association of ΔNIHSS6-24h with 90-day favorable outcomes (modified Rankin Scale score 0-2) was assessed. Independent analysis was performed using data from the 2 NINDS-tPA stroke trials (National Institute of Neurological Disorders and Stroke rt-PA). For 2555 patients with AIS, median baseline NIHSS was 9 (interquartile range, 4-16), and median ΔNIHSS6-24h was 2 (interquartile range, 0-5). In a multivariable model, baseline NIHSS, tPA-treatment, age, glucose, site, and systolic blood pressure independently predicted ΔNIHSS6-24h (R2=0.15). In the large vessel occlusion subcohort, early sustained recanalization and hemorrhagic transformation increased the explained variance (R2=0.27), but much of the variance remained unexplained. ΔNIHSS6-24h had a significant and independent association with 90-day favorable outcome. For the subjects in the 2 NINDS-tPA trials, ΔNIHSS3-24h was similarly associated with 90-day outcomes. The dynamic phenotype, ΔNIHSS6-24h, captures both explained and unexplained mechanisms involved in AIS and is significantly and independently associated with long-term outcomes. Thus, ΔNIHSS6-24h promises to be an easily obtainable and meaningful quantitative phenotype for large-scale genomic studies of AIS.
YR 2020
FD 2020-12-15
LK http://hdl.handle.net/10668/16791
UL http://hdl.handle.net/10668/16791
LA en
DS RISalud
RD Apr 28, 2025