Abstract TP280: Risk Factors Predicting Progression in Penetrating Artery Territory Infarction; a Retrospective Study
[Background] The patients with penetrating artery territory infarction (PATI) sometimes show progressive motor deficits during the acute stage with poor prognosis. Although some predicting factors are suggested concerning symptomatic progression (SP), there have been no established predicting indices and medical therapy to suppress SP. In this study, we investigated the clinical factors including medical therapy related with SP in PATI .
[Methods] We retrospectively examined acute stroke patients with PATI for recent two years in collaborative hospitals. SP was defined as the increase of at least one point on the National Institutes of Health Stroke Scale (NIHSS). The influence of factors including age, sex, medical history, vital signs and laboratory data on admission, and medical therapies, on SP were determined by multivariable logistic regression.
[Result] Five hundreds and eight patients (320 men with a mean age of 70 years) with PATI were consecutively enrolled. The mean modified Rankin scale (mRS) before the onset was 0, and average NIHSS score on admission (adNIHSS) was 3. Sixty six patients (13%) exhibited SP. On univariable analysis, the following factors were risk factors of SP: adNIHSS, systolic blood presseure on admission (adsBP), BUN, HbA1c, LDL-C. Dual antiplatelet therapy (DAPT) was administered to more patients with SP than to those without SP within 24 hours after admission. Outcome measure using mRS at 3 months after ictus was worse in patients with SP than in those without SP (3 vs 1, p<0.0001), while DAPT appeared to bring about the slight improvement of 3 months prognosis. Multivariable analysis revealed that higher HbA1c (OR 1.36, 95%CI 1.14-1.63), BUN (OR 1.33, 95%CI 1.04-1.38) and adSBP (OR 1.23, 95%CI 1.11-1.38) were independent predictors for SP in PATI.
[Conclusions] In our retrospective study, more than 10% of patients with PATI showed progressive course in the acute stage with poor prognosis despite the best available therapy. Initial high blood pressure, diabetic and dehydration tendency on admission influenced the early progression in penetrating artery territory cerebral infarction with poor outcome.
- © 2012 by American Heart Association, Inc.