Abstract TMP17: Serial ASPECTS from Baseline to 24 Hours in SWIFT: A Novel Surrogate Endpoint for Revascularization in Acute Stroke
Background: ASPECTS on baseline imaging is a known predictor of outcome in acute stroke. Change on serial ASPECTS after revascularization at 24 hrs may provide an early biomarker of therapeutic success or failure. We analyzed ASPECTS on baseline and 24-hr imaging in SWIFT to determine prognostic value and identify subgroups with extensive injury after intervention.
Methods: ASPECTS at baseline and 24 hrs was independently scored by 2 imaging experts (disagreements resolved by consensus) in all anterior circulation SWIFT cases, blind to all other trial data. ASPECTS score at baseline, at 24 hrs, and serial changes were analyzed with univariate and multivariate approaches.
Results: 138 patients (mean age 67 yrs (SD 12), 52% female, median NIHSS 18 (IQR 8-28)) with full data were studied. Baseline ASPECTS (n=139) was 0-7 in 30 (22%), 8 in 34 (25%), 9 in 42 (30%) and 10 in 33 (24%). 24-hr ASPECTS (n=139) was 0 in 25 (18%), 1-4 in 35 (25%), 5-7 in 35 (25%) and 8-10 in 44 (31%). Baseline ASPECTS of 0-7 was related to worse NIHSS (OR 1.176, p=0.006) and absence of CAD (OR 0.20, p=0.008). Lower 24-hr ASPECTS was related to worse baseline NIHSS (p=0.003) and higher baseline SBP (p=0.033). Interestingly, baseline ASPECTS was linked with Day 7/discharge NIHSS (p=0.008) and Day 90 mRS (p=0.066), yet not TICI 2b/3 reperfusion or hemorrhage. 24-hr ASPECTS was closely linked with these outcome variables (all p<0.01). Multivariate model showed higher 24-hr ASPECTS predicted good clinical outcome (Day 90 mRS 0-2): OR 1.67, p<0.001. Among patients with high baseline ASPECTS scores (8-10; n=109), dramatic infarct progression (decrease in ASPECTS ≥ 6 points at 24 hrs) was noted in 31/109 (28%). Predictors of dramatic infarct progression were higher baseline SBP (p=0.019), higher baseline blood glucose (p=0.133), and failure to acheive TICI 2b/3 reperfusion (p<0.001). Such patients had worse Day 90 mRS outcomes (mean mRS 4.4 vs. 2.7, p<0.001).
Conclusions: 24-hr ASPECTS provides better prognostic information than baseline ASPECTS. Predictors of dramatic infarct progression on ASPECTS are hyperglycemia, hypertension and nonreperfusion. Serial ASPECTS score change from baseline to 24 hrs predicts clinical outcome and may serve as a useful, early surrogate endpoint for thrombectomy trials.
- © 2012 by American Heart Association, Inc.