Prediktory návratu k pre-iktovému funkčnímu stavu po reperfuzní léčbě u pacientů s premorbidní disabilitou: post-hoc analýza českého registru

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Authors: I. Szegedi ^1-3; A. Ganesh ⁴; A. Tomek ⁵; M. Bar ^1,6; R. Pádr ⁷; F. Cihlář ⁸; S. Ostrý ^9,10; L. Kočí ¹¹; M. Kovář ¹²; P. Ševčík ¹³; V. Rohan ¹³; M. Slovák ¹⁴; D. Černík ^15,16; R. Jura ¹⁷; D. Václavík ¹⁸; M. D. Hill ^4,19; R. Mikulík ^20,21; O. Volný ^1,6
Authors‘ workplace: Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic ¹; Department of Neurology, University of Debrecen, Debrecen, Hungary ²; Lendület “Momentum” Hemostasis and Stroke Research Group of the Hungarian Academy of Sciences, Debrecen, Hungary ³; Calgary Stroke Program, Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O’Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada ⁴; Department of Neurology, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic ⁵; Center of Clinical Neurosciences, Faculty of Medicine, University Ostrava, Ostrava, Czech Republic ⁶; Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic ⁷; Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic ⁸; Department of Neurology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic ⁹; Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Czech Republic ¹⁰; Neurocenter, Regional Hospital Liberec, Liberec, Czech Republic ¹¹; Department of Neurology, Na Homolce Hospital, Prague, Czech Republic ¹²; Department of Neurology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic ¹³; Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic ¹⁴; Comprehensive stroke center, Department of Neurology, Masaryk Hospital, Krajska zdravotni as, Ustí nad Labem, Czech Republic ¹⁵; Comprehensive Stroke Center, Department of Neurology, Palacky University Medical School and University Hospital Olomouc, Czech Republic ¹⁶; Department of Neurology, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic ¹⁷; Department of Neurology, AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Ostrava, Czech Republic ¹⁸; Departments of Radiology and Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada ¹⁹; International Clinical Research Centre, Stroke Research Program, St. Anne’s University Hospital, Brno, Czech Republic ²⁰; Neurology Department, Tomas Bata Regional Hospital, Zlin, Czech Republic ²¹
Published in: Cesk Slov Neurol N 2025; 88(6): 383-387
Category: Letter to Editor
doi: https://doi.org/10.48095/cccsnn2025383

Overview

Východiska a cíle: Způsobilost pacientů s akutní ischemickou CMP (iCMP) s premorbidní disabilitou (pre-iktová modifikovaná Rankinova škála [mRS] ≥≥ 3) pro akutní reperfuzní terapii zůstává nejistá. Cílem bylo identifikovat faktory předpovídající návrat k původnímu funkčnímu stavu po reperfuzní terapii u pacientů s akutní iCMP s premorbidní disabilitou (pre-iktová mRS ≥ 3). Metody: Analyzovali jsme data pacientů s premorbidní disabilitou z českého národního registru pro intravenózní trombolýzu/endovaskulární léčbu (2016–2020). Primárním výstupem byl návrat k výchozí mRS (DmRS = 0) ve 3 měsících. Pomocí multivariátní logistické regrese jsme identifikovali prediktory tohoto výsledku. Výsledky: Z 1 712 pacientů se 32,1 % (275/857) vrátilo k výchozímu stavu. Nezávislými prediktory úspěšného návratu byly: věk (adjusted odds r atio [aOR] 0,97 na rok, 95% interval spolehlivosti [CI] 0,95–0,98), výchozí National Institutes of Health Stroke Scale (NIHSS) (aOR 0,94 na bod, 95% CI 0,92–0,96), nepřítomnost fibrilace síní (aOR 0,78, 95% CI 0,63–0,97) a čas od vzniku příznaků do zahájení léčby (aOR 0,99 na minutu, 95% CI 0,98–0,99). Pacienti s premorbidním mRS 3 se s větší pravděpodobností vrátili k výchozímu stavu než pacienti s mRS 4–5 (aOR 1,42, 95% CI 1,18–1,67). Reperfuze byla účinnější u pacientů s aterotrombotickou etiologií iktu (aOR 1,69, 95% CI 1,31–2,14) ve srovnání s kardioembolickou etiologií (aOR 1,21, 95% CI 0,95–1,53). Diskuze: Nižší věk, nižší NIHSS, nepřítomnost fibrilace síní, aterotrombotická etiologie a rychlejší zahájení léčby jsou klíčovými prediktory návratu k výchozímu funkčnímu stavu po reperfuzi u pacientů s akutní iCMP s premorbidní disabilitou.

Sources

1. Papanagiotou P, White CJ. Endovascular reperfusion strategies for acute stroke. JACC Cardiovasc Interv 2016; 9 (4): 307–317. doi: 10.1016/j.jcin.2015.11.014.

2. Ganesh A, Luengo-Fernandez R, Pendlebury ST et al. Long-term consequences of worsened poststroke status in patients with premorbid disability. Stroke 2018; 49 (10): 2430–2436. doi: 10.1161/STROKEAHA.118. 022416.

3. Gumbinger C, Ringleb P, Ippen F et al. Outcomes of patients with stroke treated with thrombolysis according to prestroke Rankin Scale scores. Neurology 2019; 93 (20): e1834–e1843. doi: 10.1212/WNL.00000000000 08468.

4. Salwi S, Niec JA, Hassan AE et al. Endovascular treatment for acute stroke patients with a pre-stroke disability: an international survey. Front Neurol 2021; 12 : 714594. doi: 10.3389/fneur.2021.714594.

5. Kwok CS, Clark A, Ford GA et al. Association between prestroke disability and inpatient mortality and length of acute hospital stay after acute stroke. J Am Geriatr Soc 2012; 60 (4): 726–732. doi: 10.1111/j.1532-5415.2011.03889.x.

6. Ganesh A, Volny O, Kovacova I et al. Utilization, workflow, and outcomes of endovascular thrombectomy in patients with vs without premorbid disability in a national registry. Neurol Clin Pract 2024; 14 (6): e200341. doi: 10.1212/CPJ.0000000000200341.

7. Adams HP Jr, Bendixen BH, Kappelle LJ et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24 (1): 35–41. doi: 10.1161/01.str.24.1.35.

8. Bala F, Beland B, Mistry E et al. Endovascular treatment of acute ischemic stroke in patients with pre-morbid disability: a meta-analysis. J Neurointerv Surg 2023; 15 (4): 343–349. doi: 10.1136/neurintsurg-2021-018573.

9. Beland B, Bala F, Ganesh A. Thrombolysis for acute ischemic stroke in patients with premorbid disability: a meta-analysis. Stroke 2022; 53 (10): 3055–3063. doi: 10.1161/STROKEAHA.121.038374.

10. Bendszus M, Fiehler J, Subtil F et al. Endovascular thrombectomy for acute ischaemic stroke with established large infarct: multicentre, open-label, randomised trial. Lancet 2023; 402 (10414): 1753–1763. doi: 10.1016/S0140-6736 (23) 02032-9.

11. Sarraj A, Hassan AE, Abraham MG et al. Trial of endovascular thrombectomy for large ischemic strokes. N Engl J Med 2023; 388 (14): 1259–1271. doi: 10.1056/NEJMoa2214403.

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Article was published in

Czech and Slovak Neurology and Neurosurgery

2025 Issue 6

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