Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke
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 Nation...
Gespeichert in:
| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2001-12, Vol.286 (22), p.2830-2838 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 2838 |
|---|---|
| container_issue | 22 |
| container_start_page | 2830 |
| container_title | JAMA : the journal of the American Medical Association |
| container_volume | 286 |
| creator | Patel, Suresh C Levine, Steven R Tilley, Barbara C Grotta, James C Lu, Mei Frankel, Michael Haley, Jr, E. Clarke Brott, Thomas G Broderick, Joseph P Horowitz, Steven Lyden, Patrick D Lewandowski, Christopher A Marler, John R Welch, K. M. A for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group |
| description | 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 (ρ = 0.23; P |
| doi_str_mv | 10.1001/jama.286.22.2830 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_72342042</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>194456</ama_id><sourcerecordid>95975581</sourcerecordid><originalsourceid>FETCH-LOGICAL-a426t-4bb327c60f62c935f56ee2bc8253a4cb294dc6171cee3d5e1d0b8a1c2cd6921f3</originalsourceid><addsrcrecordid>eNqF0c9LwzAUB_AgipvTu14kCHrrzO-mx1GmDgYeNq-WNE23bG0zm_aw_97IJgMv5vJC3ofA-z4AbjEaY4Tw80bVakykGBMSCkVnYIg5lRHliTwHQ4QSGcVMsgG48n6DwsE0vgQDjGPKYy6H4HOu9Ba6EqaVbaxWFVzYVWPLcG20-WlMVVvt4czrtamthulaNSvjoWtg6upd35kCLl3tVq3arffQNnCiwyNcdK3bmmtwUarKm5tjHYGPl-kyfYvm76-zdDKPFCOii1ieUxJrgUpBdEJ5yYUxJNeScKqYzknCCi1wjLUxtOAGFyiXCmuiC5EQXNIReDr8u2vdV298l9XWa1NVqjGu91lMKCOIkX8hlgwRkfAAH_7AjevbJgyREYwpFywWAd0fUZ_Xpsh2ra1Vu89-8w3g8QiUD-GWbUjV-pOjDIeVJMHdHVxY6KmbMMYF_QagCZEV</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211356476</pqid></control><display><type>article</type><title>Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Patel, Suresh C ; Levine, Steven R ; Tilley, Barbara C ; Grotta, James C ; Lu, Mei ; Frankel, Michael ; Haley, Jr, E. Clarke ; Brott, Thomas G ; Broderick, Joseph P ; Horowitz, Steven ; Lyden, Patrick D ; Lewandowski, Christopher A ; Marler, John R ; Welch, K. M. A ; for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creator><creatorcontrib>Patel, Suresh C ; Levine, Steven R ; Tilley, Barbara C ; Grotta, James C ; Lu, Mei ; Frankel, Michael ; Haley, Jr, E. Clarke ; Brott, Thomas G ; Broderick, Joseph P ; Horowitz, Steven ; Lyden, Patrick D ; Lewandowski, Christopher A ; Marler, John R ; Welch, K. M. A ; for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group ; National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creatorcontrib><description>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 (ρ = 0.23; P<.001) and time from
stroke onset to baseline CT scan (ρ = 0.11; P
= .007). After adjusting for baseline variables, there was no EIC ×
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.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.286.22.2830</identifier><identifier>PMID: 11735758</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Aged ; Biological and medical sciences ; Brain Ischemia - diagnostic imaging ; Drug therapy ; Humans ; Intracranial Hemorrhages - diagnostic imaging ; Investigative techniques, diagnostic techniques (general aspects) ; Logistic Models ; Medical sciences ; Middle Aged ; Nervous system ; Neurology ; Plasminogen Activators - therapeutic use ; Poisson Distribution ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Recombinant Proteins ; Risk ; Severity of Illness Index ; Stroke ; Stroke - diagnostic imaging ; Stroke - drug therapy ; Stroke - physiopathology ; Survival Analysis ; Time Factors ; Tissue Plasminogen Activator - therapeutic use ; Tomography ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>JAMA : the journal of the American Medical Association, 2001-12, Vol.286 (22), p.2830-2838</ispartof><rights>2002 INIST-CNRS</rights><rights>Copyright American Medical Association Dec 12, 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a426t-4bb327c60f62c935f56ee2bc8253a4cb294dc6171cee3d5e1d0b8a1c2cd6921f3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.286.22.2830$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.286.22.2830$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3326,27903,27904,76236,76239</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13410139$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11735758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patel, Suresh C</creatorcontrib><creatorcontrib>Levine, Steven R</creatorcontrib><creatorcontrib>Tilley, Barbara C</creatorcontrib><creatorcontrib>Grotta, James C</creatorcontrib><creatorcontrib>Lu, Mei</creatorcontrib><creatorcontrib>Frankel, Michael</creatorcontrib><creatorcontrib>Haley, Jr, E. Clarke</creatorcontrib><creatorcontrib>Brott, Thomas G</creatorcontrib><creatorcontrib>Broderick, Joseph P</creatorcontrib><creatorcontrib>Horowitz, Steven</creatorcontrib><creatorcontrib>Lyden, Patrick D</creatorcontrib><creatorcontrib>Lewandowski, Christopher A</creatorcontrib><creatorcontrib>Marler, John R</creatorcontrib><creatorcontrib>Welch, K. M. A</creatorcontrib><creatorcontrib>for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creatorcontrib><creatorcontrib>National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creatorcontrib><title>Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>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 (ρ = 0.23; P<.001) and time from
stroke onset to baseline CT scan (ρ = 0.11; P
= .007). After adjusting for baseline variables, there was no EIC ×
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.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Drug therapy</subject><subject>Humans</subject><subject>Intracranial Hemorrhages - diagnostic imaging</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Logistic Models</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Neurology</subject><subject>Plasminogen Activators - therapeutic use</subject><subject>Poisson Distribution</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Recombinant Proteins</subject><subject>Risk</subject><subject>Severity of Illness Index</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - drug therapy</subject><subject>Stroke - physiopathology</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c9LwzAUB_AgipvTu14kCHrrzO-mx1GmDgYeNq-WNE23bG0zm_aw_97IJgMv5vJC3ofA-z4AbjEaY4Tw80bVakykGBMSCkVnYIg5lRHliTwHQ4QSGcVMsgG48n6DwsE0vgQDjGPKYy6H4HOu9Ba6EqaVbaxWFVzYVWPLcG20-WlMVVvt4czrtamthulaNSvjoWtg6upd35kCLl3tVq3arffQNnCiwyNcdK3bmmtwUarKm5tjHYGPl-kyfYvm76-zdDKPFCOii1ieUxJrgUpBdEJ5yYUxJNeScKqYzknCCi1wjLUxtOAGFyiXCmuiC5EQXNIReDr8u2vdV298l9XWa1NVqjGu91lMKCOIkX8hlgwRkfAAH_7AjevbJgyREYwpFywWAd0fUZ_Xpsh2ra1Vu89-8w3g8QiUD-GWbUjV-pOjDIeVJMHdHVxY6KmbMMYF_QagCZEV</recordid><startdate>20011212</startdate><enddate>20011212</enddate><creator>Patel, Suresh C</creator><creator>Levine, Steven R</creator><creator>Tilley, Barbara C</creator><creator>Grotta, James C</creator><creator>Lu, Mei</creator><creator>Frankel, Michael</creator><creator>Haley, Jr, E. Clarke</creator><creator>Brott, Thomas G</creator><creator>Broderick, Joseph P</creator><creator>Horowitz, Steven</creator><creator>Lyden, Patrick D</creator><creator>Lewandowski, Christopher A</creator><creator>Marler, John R</creator><creator>Welch, K. M. A</creator><creator>for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20011212</creationdate><title>Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke</title><author>Patel, Suresh C ; Levine, Steven R ; Tilley, Barbara C ; Grotta, James C ; Lu, Mei ; Frankel, Michael ; Haley, Jr, E. Clarke ; Brott, Thomas G ; Broderick, Joseph P ; Horowitz, Steven ; Lyden, Patrick D ; Lewandowski, Christopher A ; Marler, John R ; Welch, K. M. A ; for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a426t-4bb327c60f62c935f56ee2bc8253a4cb294dc6171cee3d5e1d0b8a1c2cd6921f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Brain Ischemia - diagnostic imaging</topic><topic>Drug therapy</topic><topic>Humans</topic><topic>Intracranial Hemorrhages - diagnostic imaging</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Logistic Models</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Neurology</topic><topic>Plasminogen Activators - therapeutic use</topic><topic>Poisson Distribution</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Recombinant Proteins</topic><topic>Risk</topic><topic>Severity of Illness Index</topic><topic>Stroke</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - drug therapy</topic><topic>Stroke - physiopathology</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patel, Suresh C</creatorcontrib><creatorcontrib>Levine, Steven R</creatorcontrib><creatorcontrib>Tilley, Barbara C</creatorcontrib><creatorcontrib>Grotta, James C</creatorcontrib><creatorcontrib>Lu, Mei</creatorcontrib><creatorcontrib>Frankel, Michael</creatorcontrib><creatorcontrib>Haley, Jr, E. Clarke</creatorcontrib><creatorcontrib>Brott, Thomas G</creatorcontrib><creatorcontrib>Broderick, Joseph P</creatorcontrib><creatorcontrib>Horowitz, Steven</creatorcontrib><creatorcontrib>Lyden, Patrick D</creatorcontrib><creatorcontrib>Lewandowski, Christopher A</creatorcontrib><creatorcontrib>Marler, John R</creatorcontrib><creatorcontrib>Welch, K. M. A</creatorcontrib><creatorcontrib>for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creatorcontrib><creatorcontrib>National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patel, Suresh C</au><au>Levine, Steven R</au><au>Tilley, Barbara C</au><au>Grotta, James C</au><au>Lu, Mei</au><au>Frankel, Michael</au><au>Haley, Jr, E. Clarke</au><au>Brott, Thomas G</au><au>Broderick, Joseph P</au><au>Horowitz, Steven</au><au>Lyden, Patrick D</au><au>Lewandowski, Christopher A</au><au>Marler, John R</au><au>Welch, K. M. A</au><au>for the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</au><aucorp>National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2001-12-12</date><risdate>2001</risdate><volume>286</volume><issue>22</issue><spage>2830</spage><epage>2838</epage><pages>2830-2838</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>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 (ρ = 0.23; P<.001) and time from
stroke onset to baseline CT scan (ρ = 0.11; P
= .007). After adjusting for baseline variables, there was no EIC ×
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.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>11735758</pmid><doi>10.1001/jama.286.22.2830</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 2001-12, Vol.286 (22), p.2830-2838 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_72342042 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Aged Biological and medical sciences Brain Ischemia - diagnostic imaging Drug therapy Humans Intracranial Hemorrhages - diagnostic imaging Investigative techniques, diagnostic techniques (general aspects) Logistic Models Medical sciences Middle Aged Nervous system Neurology Plasminogen Activators - therapeutic use Poisson Distribution Radiodiagnosis. Nmr imagery. Nmr spectrometry Recombinant Proteins Risk Severity of Illness Index Stroke Stroke - diagnostic imaging Stroke - drug therapy Stroke - physiopathology Survival Analysis Time Factors Tissue Plasminogen Activator - therapeutic use Tomography Tomography, X-Ray Computed Treatment Outcome Vascular diseases and vascular malformations of the nervous system |
| title | Lack of Clinical Significance of Early Ischemic Changes on Computed Tomography in Acute Stroke |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T06%3A59%3A19IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Lack%20of%20Clinical%20Significance%20of%20Early%20Ischemic%20Changes%20on%20Computed%20Tomography%20in%20Acute%20Stroke&rft.jtitle=JAMA%20:%20the%20journal%20of%20the%20American%20Medical%20Association&rft.au=Patel,%20Suresh%20C&rft.aucorp=National%20Institute%20of%20Neurological%20Disorders%20and%20Stroke%20rt-PA%20Stroke%20Study%20Group&rft.date=2001-12-12&rft.volume=286&rft.issue=22&rft.spage=2830&rft.epage=2838&rft.pages=2830-2838&rft.issn=0098-7484&rft.eissn=1538-3598&rft.coden=JAMAAP&rft_id=info:doi/10.1001/jama.286.22.2830&rft_dat=%3Cproquest_pubme%3E95975581%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=211356476&rft_id=info:pmid/11735758&rft_ama_id=194456&rfr_iscdi=true |