Why the study?
Blood pressure variability is linked to worse neurological outcomes after IVT for acute ischaemic stroke, but whether pulse pressure variability is a superior indicator of total cardiovascular risk remained uninvestigated.
Is pulse pressure variability associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis?
Is pulse pressure variability associated with unfavorable outcomes in acute ischaemic stroke patients treated with intravenous thrombolysis?
Increased pulse pressure variability in the first 24 hours after intravenous thrombolysis for acute ischemic stroke is independently associated with worse functional outcomes, higher mortality, and increased intracranial bleeding.
24-h pulse pressure variability after thrombolysis was associated with worse outcomes; hypothesis-generating for prospective trials before clinical adoption.
BACKGROUND AND PURPOSE: Blood pressure (BP) variability has been associated with worse neurological outcomes in acute ischaemic stroke (AIS) patients receiving treatment with intravenous thrombolysis (IVT). However, no study to date has investigated whether pulse pressure (PP) variability may be a superior indicator of the total cardiovascular risk, as measured by clinical outcomes. METHODS: Pulse pressure variability was calculated from 24-h PP measurements following tissue plasminogen activator bolus in AIS patients enrolled in the Combined Lysis of Thrombus using Ultrasound and Systemic Tissue Plasminogen Activator for Emergent Revascularization (CLOTBUST-ER) trial. The outcomes of interest were the pre-specified efficacy and safety end-points of CLOTBUST-ER. All associations were adjusted for potential confounders in multivariable regression models. RESULTS: Data from 674 participants was analyzed. PP variability was identified as the BP parameter with the most parsimonious fit in multivariable models of all outcomes, and was independently associated (P < 0.001) with lower likelihood of both 24-h neurological improvement and 90-day independent functional outcome. PP variability was also independently related to increased odds of any intracranial bleeding (P = 0.011) and 90-day mortality (P < 0.001). Every 5-mmHg increase in the 24-h PP variability was independently associated with a 36% decrease in the likelihood of 90-day independent functional outcome (adjusted odds ratio 0.64, 95% confidence interval 0.52-0.80) and a 60% increase in the odds of 90-day mortality (adjusted odds ratio 1.60, 95% confidence interval 1.23-2.07). PP variability was not associated with symptomatic intracranial bleeding at either 24 or 36 h after IVT administration. CONCLUSIONS: Increased PP variability appears to be independently associated with adverse short-term and long-term functional outcomes of AIS patients treated with IVT.
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Katsanos et al. (2020) studied this question.
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