| Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. | |
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MedLine Citation:
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PMID: 11735758 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: The prevalence and clinical significance of early ischemic changes (EICs) on baseline computed tomography (CT) scan of the head obtained within 3 hours of ischemic stroke are not established. OBJECTIVE: To determine the frequency and significance of EIC on baseline head CT scans in the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA (recombinant tissue plasminogen activator) Stroke Trial. DESIGN AND SETTING: The original study, a randomized controlled trial, took place from January 1991 through October 1994 at 43 sites, during which CT images were obtained within 3 hours of symptom onset and prior to the initiation of rt-PA or placebo. For the current analysis, detailed reevaluation was undertaken after October 1994 of all baseline head CT scans with clinical data available pretreatment (blinded to treatment arm). PATIENTS: Of 624 patients enrolled in the trial, baseline CT scans were retrieved and reviewed for 616 (99%). MAIN OUTCOME MEASURES: Frequency of EICs on baseline CT scans; association of EIC with other baseline variables; effect of EICs on deterioration at 24 hours (>/=4 points increase from the baseline National Institutes of Health Stroke Scale [NIHSS] score); clinical outcome (measured by 4 clinical scales) at 3 months, CT lesion volume at 3 months, death at 90 days; and symptomatic intracranial hemorrhage (ICH) within 36 hours of treatment. RESULTS: The prevalence of EIC on baseline CT in the combined rt-PA and placebo groups was 31% (n = 194). The EIC was significantly associated with baseline NIHSS score (rho = 0.23; P<.001) and time from stroke onset to baseline CT scan (rho = 0.11; P =.007). After adjusting for baseline variables, there was no EIC x treatment interaction detected for any clinical outcome, including deterioration at 24 hours, 4 clinical scales, lesion volume, and death at 90 days (P>/=.25), implying that EIC is unlikely to affect response to rt-PA treatment. After adjusting for NIHSS score (an independent predictor of ICH), no EIC association with symptomatic ICH at 36 hours was detected in the group treated with rt-PA (P>/=.22). CONCLUSIONS: Our analysis suggests that EICs are prevalent within 3 hours of stroke onset and correlate with stroke severity. However, EICs are not independently associated with increased risk of adverse outcome after rt-PA treatment. Patients treated with rt-PA did better whether or not they had EICs, suggesting that EICs on CT scan are not critical to the decision to treat otherwise eligible patients with rt-PA within 3 hours of stroke onset. |
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Authors:
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S C Patel; S R Levine; B C Tilley; J C Grotta; M Lu; M Frankel; E C Haley; T G Brott; J P Broderick; S Horowitz; P D Lyden; C A Lewandowski; J R Marler; K M Welch; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 286 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 2001 Dec |
Date Detail:
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Created Date: 2001-12-12 Completed Date: 2001-12-28 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2830-8 Citation Subset: AIM; IM |
Affiliation:
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Division of Neuroradiology, Henry Ford Hospital and Health Science Centers, 2799 W Grand Blvd, K-3, Detroit, MI 48202-2689, USA. spatel@rad.hfh.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Brain Ischemia / radiography* Humans Intracranial Hemorrhages / radiography Logistic Models Middle Aged Plasminogen Activators / therapeutic use* Poisson Distribution Recombinant Proteins Risk Severity of Illness Index Stroke / drug therapy*, physiopathology, radiography* Survival Analysis Time Factors Tissue Plasminogen Activator / therapeutic use* Tomography, X-Ray Computed Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Recombinant Proteins; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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JAMA. 2002 May 8;287(18):2361-2; author reply 2362
[PMID:
11988052
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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