PREDICTORS AND CLINICAL IMPACT OF INFARCT PROGRESSION RATE IN THE ESCAPE-NA1 TRIAL
- Johanna Ospel (Switzerland)
Abstract
Group Name
on behalf of the ESCAPE-NA1 investigators
Background And Aims
Determining infarct progression rate in acute ischemic stroke (AIS) is important for patient triage, treatment decision-making and outcome prognostication. We estimated infarct progression rate in AIS patients with large vessel occlusion (LVO) and determined its predictors and impact on clinical outcome.
Methods
AIS patients with time from last-known-well-to-randomization<6h and near-complete reperfusion following EVT (eTICI 2c/3) were included in this study. Infarct growth rate (mL/h) was estimated by dividing 24h infarct volume (measured on NCCT or DWI-MRI) by time from last-known-well-to-reperfusion. Multivariable linear regression was used to assess the association of patient baseline variables with log-transformed infarct progression rate. The association of infarct progression rate and good outcome (mRS 0-2 at 90d) was determined using multivariable logistic regression.
Results
Four-hundred-two patients were included in the study. Median infarct progression rate was 4.73 mL/h (IQR:1.24-14.85). Collateral status (β:-0.83[95%CI:-1.22;-0.44]), Alberta Stroke Program Early CT-Score (ASPECTS,β:-0.35[95%CI:-0.47;-0.24]) and National Institutes of Health Stroke Scale (NIHSS,β:0.07[95%CI:0.04;0.10]) were associated with log-transformed infarct progression rate. Patients’ clinical and imaging baseline variables explained 20% of the variance in infarct progression rate. Infarct progression rate was significantly associated with good outcome (aOR per 1mL/h increase: 0.96[95%CI:0.95;0.98], see figure).
Conclusions
In this sample of early time window LVO-patients who underwent successful recanalization, infarct progression rate was inversely correlated with good clinical outcome. While a significant association between ASPECTS, collateral status and NIHSS and infarct progression rate was observed, these baseline imaging and clinical characteristics explained only a small proportion of the inter-individual variance, suggesting the need for more research on measurable factors affecting infarct growth.
Trial Registration Number
NCT02930018