Abstract TP68: Initial NIHSS and Age Are Major Predictors for Acute Symptom Progression: Exploratory Analysis of the Pentagon Study
Background and Purpose: Early neurological deterioration occurs in 25-48% of patients with acute ischemic stroke resulting in poor outcome. We have conducted an exploratory analysis of the PrevEntioN using cilosTazol from Acute stroke proGressiON (Pentagon) study to elucidate the predictor of progressing stroke.
Methods: Pentagon was a multi-center, open, randomized, prospective comparative study (UMIN Clinical Trial ID: UMIN000004016). Patients with non-cardioembolic stroke were administered either cilostazol 200 mg daily or aspirin 200 mg daily within 48 hours of onset. Other stroke managements were in accord with guideline recommendation throughout the follow up until 3 months. Primary endpoint was occurrence of acute symptom progression (ΔNIHSS ≥2) within 7 days. Main secondary endpoint was independence at 3 months (mRS 0-2). After comparing baseline characteristics, vascular risk factors and treatment allocation, multivariate logistic regression analysis were performed to evaluate the factors related to acute symptom progression and 3-month outcome.
Results: Among 201 patients (124 men, 71.2±11.4 years, NIHSS median 3, IQR 1-5), symptom progression was observed in 21 patients (10.5%). Age ≥75 years (p=0.0006) and initial NIHSS ≥5 (p=0.0010) were significantly related. When treated with aspirin (n=95), more patients with severe NIHSS experienced symptom progression (NIHSS ≤4: 7.1%, 5-7: 25.0%, ≥8: 22.2%). In patients treated with cilostazol (n=106), on the other hand, no patients with NIHSS ≥8 experienced symptom progression (NIHSS ≤4: 5.0%, 5-7: 33.3%, ≥8: 0%). In total, 138 patients (68.7%) achieved mRS 0-2 at 3 months. Age ≥75 years (p<0.0001) and initial NIHSS ≥5 (p=0.0002) were negatively associated. A logistic regression model revealed that younger age (p<0.0001), lower NIHSS (p<0.0001) and cilostazol treatment (p=0.0437) were related to mRS 0-2 at 3 months.
Conclusions: Initial NIHSS ≥5 and advanced age ≥75 years are major predictors for acute symptom progression. Although effect on preventing symptom progression was comparable, better long-term outcome might be expected with acute cilostazol treatment.
- © 2012 by American Heart Association, Inc.