Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis

Susan J. Carr, Xia Wang, Veronica V. Olavarria, Pablo M. Lavados, Jorge A. Rodriguez, Jong S. Kim, Tsong Hai Lee, Richard I. Lindley, Octavio M. Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K. Sharma, Mark Woodward, John Chalmers, Craig S. Anderson, Thompson G. Robinson

Resultado de la investigación: Article

7 Citas (Scopus)

Resumen

Background and Purpose - Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods - A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. Results - Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. Conclusions - RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.

Idioma originalEnglish
Páginas (desde-hasta)2605-2609
Número de páginas5
PublicaciónStroke
Volumen48
N.º9
DOI
EstadoPublished - 1 sep 2017
Publicado de forma externa

Huella dactilar

Tissue Plasminogen Activator
Stroke
Hypertension
Kidney
Odds Ratio
Cerebral Hemorrhage
Confidence Intervals
Glomerular Filtration Rate
Mortality
Uncertainty

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Citar esto

Carr, Susan J. ; Wang, Xia ; Olavarria, Veronica V. ; Lavados, Pablo M. ; Rodriguez, Jorge A. ; Kim, Jong S. ; Lee, Tsong Hai ; Lindley, Richard I. ; Pontes-Neto, Octavio M. ; Ricci, Stefano ; Sato, Shoichiro ; Sharma, Vijay K. ; Woodward, Mark ; Chalmers, John ; Anderson, Craig S. ; Robinson, Thompson G. / Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke : ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis. En: Stroke. 2017 ; Vol. 48, N.º 9. pp. 2605-2609.
@article{a61f3ac1aee043e08a36c3f3af7ba9d7,
title = "Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis",
abstract = "Background and Purpose - Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods - A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8{\%} women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8{\%}) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. Results - Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95{\%} confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9{\%} increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95{\%} confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95{\%} confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. Conclusions - RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.",
keywords = "glomerular filtration rate, hypertension, intracranial hemorrhages, odds ratio, stroke",
author = "Carr, {Susan J.} and Xia Wang and Olavarria, {Veronica V.} and Lavados, {Pablo M.} and Rodriguez, {Jorge A.} and Kim, {Jong S.} and Lee, {Tsong Hai} and Lindley, {Richard I.} and Pontes-Neto, {Octavio M.} and Stefano Ricci and Shoichiro Sato and Sharma, {Vijay K.} and Mark Woodward and John Chalmers and Anderson, {Craig S.} and Robinson, {Thompson G.}",
year = "2017",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.117.017808",
language = "English",
volume = "48",
pages = "2605--2609",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

Carr, SJ, Wang, X, Olavarria, VV, Lavados, PM, Rodriguez, JA, Kim, JS, Lee, TH, Lindley, RI, Pontes-Neto, OM, Ricci, S, Sato, S, Sharma, VK, Woodward, M, Chalmers, J, Anderson, CS & Robinson, TG 2017, 'Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis', Stroke, vol. 48, n.º 9, pp. 2605-2609. https://doi.org/10.1161/STROKEAHA.117.017808

Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke : ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis. / Carr, Susan J.; Wang, Xia; Olavarria, Veronica V.; Lavados, Pablo M.; Rodriguez, Jorge A.; Kim, Jong S.; Lee, Tsong Hai; Lindley, Richard I.; Pontes-Neto, Octavio M.; Ricci, Stefano; Sato, Shoichiro; Sharma, Vijay K.; Woodward, Mark; Chalmers, John; Anderson, Craig S.; Robinson, Thompson G.

En: Stroke, Vol. 48, N.º 9, 01.09.2017, p. 2605-2609.

Resultado de la investigación: Article

TY - JOUR

T1 - Influence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke

T2 - ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis

AU - Carr, Susan J.

AU - Wang, Xia

AU - Olavarria, Veronica V.

AU - Lavados, Pablo M.

AU - Rodriguez, Jorge A.

AU - Kim, Jong S.

AU - Lee, Tsong Hai

AU - Lindley, Richard I.

AU - Pontes-Neto, Octavio M.

AU - Ricci, Stefano

AU - Sato, Shoichiro

AU - Sharma, Vijay K.

AU - Woodward, Mark

AU - Chalmers, John

AU - Anderson, Craig S.

AU - Robinson, Thompson G.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Background and Purpose - Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods - A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. Results - Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. Conclusions - RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.

AB - Background and Purpose - Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods - A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, <60 mL/min per 1.73 m2) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models. Results - Compared with patients with normal renal function (>90 mL/min per 1.73 m2), those with severe RD (<30 mL/min per 1.73 m2) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m2 lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades. Conclusions - RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.

KW - glomerular filtration rate

KW - hypertension

KW - intracranial hemorrhages

KW - odds ratio

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85025833350&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.117.017808

DO - 10.1161/STROKEAHA.117.017808

M3 - Article

C2 - 28739832

AN - SCOPUS:85025833350

VL - 48

SP - 2605

EP - 2609

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -