Abstract WP248: Pre-treatment Perfusion CT in Stroke Thrombolysis Can Predict Disability-free Life
Introduction: Stroke shortens an individual’s disability-free life. We aimed to assess the relative prognostic influence of pre- and post-treatment perfusion CT imaging variables (e.g. ischemic core and penumbral volumes) compared to standard clinical predictors (such as onset-to-treatment time) on long-term stroke disability in patients undergoing thrombolysis.
Methods: We used data from a prospectively collected international, multicenter, observational registry of acute ischemic stroke patients who had perfusion CT and CT angiography before treatment with intravenous alteplase. Baseline perfusion CT and follow-up MRI were analysed to derive the baseline penumbra volume, baseline ischemic core volume, and penumbra salvaged from infarction. The primary outcome measure was the effect of imaging and clinical variables on disability-adjusted life years (DALY). Clinical variables were age, sex, NIHSS score, and onset-to-treatment time. Age, sex, country, and 3-month modified Rankin Scale were extracted from the registry to calculate DALY due to stroke, such that one year of DALY equates to 1 year of healthy life lost due to stroke.
Results: Seven hundred seventy two patients were treated with alteplase therapy. 17.5 DALY-days were lost per 1 mL of baseline ischemic core volume (95%CI, 13.2 - 21.9 days, p < 0.001). For every mL of penumbra salvaged, 7.2 days of DALY-days were saved (95%CI, 4.1 - 10.4 days, p < 0.001). Each minute of earlier onset-to-treatment time resulted in a saving of 4.4 disability-free days after stroke (1.3 - 7.5 days, p = 0.006). However, after adjustment for imaging variables, onset-to-treatment time was not significantly associated with savings in DALY-days.
Conclusions: Pre-treatment perfusion CT scan defined penumbra (independently of clinical variables) predict significant gains, or loss, of disability-free life in patients undergoing reperfusion therapy for stroke. The effect of earlier treatment on disability-free life appears explained by salvage of penumbra.
Author Disclosures: H. Kawano: Research Grant; Modest; Daiichi-Sankyo Foundation of Life Science. A. Bivard: Research Grant; Modest; National Health and Medical Research Council early career fellowship. L. Lin: None. H. Ma: None. X. Cheng: Research Grant; Modest; Science and Technology Commission of the Shanghai Municipality. R. Aviv: Other Research Support; Modest; Biogen research grant. Research Grant; Significant; CIHR paid to institution. B. O’Brien: None. K. Butcher: Research Grant; Modest; a Canada Research Chair in Cerebrovascular Disease, the Heart and Stroke Foundation of Alberta Professorship in Stroke Medicine, an Alberta Innovates Health Solutions Clinical Investigator Award and g, an Alberta Innovates Health Solutions Clinical Investigator Award, grant in aid funding from the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Canada. M. Lou: None. J. Zhang: None. J. Jannes: Research Grant; Modest; grants from The Queen Elizabeth Hospital. Q. Dong: None. C.R. Levi: Research Grant; Significant; National Health and Medical Research Council Practitioner Fellowship. M.W. Parsons: Research Grant; Significant; Australian Research Council Future Fellowship.
- © 2017 by American Heart Association, Inc.