London, United Kingdom 2013 12 Large clinical trials (RCTs) B 12:20 - 12:30 Does perfusion imaging lesion size or mismatch influence six month outcomes after rt-PA given up to six hours after acute ischaemic stroke? The Third International Stroke Trial (IST-3). J.M. Wardlaw1, T. Carpenter2, G. Cohen3, R. von Kummer4, R. Lindley5, P. Sandercock6 The Third International Stroke Trial (IST-3) Collaborative Group University of Edinburgh, Edinburgh, UNITED KINGDOM1,University of Edinburgh, Ed-inburgh, UNITED KINGDOM2, University of Edinburgh, Edinburgh, UNITED KINGDOM3, University of Dresden, Dresden, GERMANY4, University of Sydney, Sydney, AUSTRALIA5, University of Edinburgh, Edinburgh, UNITED KINGDOM6 Aim: Perfusion imaging (PI) can identify brain ‘at risk’ of infarction. We analysed patients randomised in IST-3 with PI to determine if PI appearance influenced the effect of rt-PA. Methods. IST-3 randomised 3035 patients to iv rt-PA (0.9mg/kg) or control <6 hours of acute ischaemic stroke. 28/156 centres collected pre-randomisation CT or MR with PI; PI data were processed centrally and read blind to other data. We scored PI lesion extent (quantitative CBF, CBV, MTT, Tmax) by ASPECTS and degree of mismatch between the PI and plain scan lesion (PI normal, <20%, same, >20% larger than plain scan lesion). An international expert panel assessed baseline plain images (blinded) for infarct site/size. We tested associations between PI lesion features and 6-month outcome (OHS 0-2) with logistic regression, adjusted for time, NIHSS, age and randomisation to rt-PA. ISRCTN25765518. Results. baseline characteristics of patients in IST-3 with PI did not differ from those without. 116/129 patients had rateable PI data. MTT lesions were largest, CBV smallest (p<0.0000). 46% had mismatch on Tmax. PI lesions were larger (all parameters) in patients scanned <3 vs 3-6 hours, aged >80 vs <80 and with higher NIHSS scores. Larger PI lesions were associated with poor outcome (odds of good outcome decreased by ∼20% per point increase in PI lesion size on ASPECTS score, signif-icant for CBV, Tmax). There was no evidence that any PI lesion parameter on PI ASPECTS score or mismatch modified rt-PA effect for 6-month outcome. The results were the same with dichotomous or ordinal analyses. Conclusion. Visually rated mismatch and PI lesion extent on several PI parameters did not identify additional features associated with more or less benefit from rt-PA. Older patients and those seen <3hrs have larger PI lesions. Large lesions on any parameter are associated with poor functional outcome. Analysis of PI volumes and outcome is ongoing Cerebrovasc Dis 2013; 35 (suppl 3)1-854 111 11 Large clinical trials (RCTs) B 12:10 - 12:20 The Impact of Blood Pressure Variability on Stroke Recurrence: The SPS3 trial T.S. Field1, K.L. Patton2, L.A. McClure3, C.R. Sussman4, C.L. White5, P.E. Pergola6, A. Cer-vantes- Arriaga7, R.A. Conwit8, R.G. Hart9, O.R. Benavente10 On behalf of the SPS3 Investigators Vancouver Stroke Program, Brain Research Center, University of British Columbia, Van-couver, CANADA1,University of Alabama at Birmingham, Birmingham, USA2, University of Alabama at Birmingham, Birmingham, USA3, Vanderbilt University, Nashville, USA4, Univer-sity of Texas Health Sciences Center at San Antonio, San Antonio, USA5, University of Texas Health Sciences Center at San Antonio, San Antonio, USA6, Neurodegenerative Research Unit, National Institute of Neurology and Neurosurgery, Mexico City, MEXICO7, National Institute of Neurological Disorders and Stroke, Bethesda, USA8, McMaster University, Hamilton, USA9, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, CANADA10 BACKGROUND Blood pressure variability (BPV) has been identified as an independent and powerful risk factor for stroke. However, the role of BPV within the same visit at baseline as a risk factor for long-term stroke recurrence is not defined. METHODS Participants from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial were in-cluded. SPS3 included patients with recent symptomatic MRI-proven lacunar infarcts. Baseline within-visit systolic blood pressure (SBP) BPV was defined by standard deviation (SD), coeffi-cient of variation (CV; equal to SD/mean) and average real variability (ARV) of the three SBP measures at the first visit. We correlated quartiles (Q) of each measure of BPV and baseline characteristics and analysed the association between BPV and recurrence of all stroke (isch-emic and hemorrhagic), ischemic stroke and death. Long-term within-visit and visit-to-visit BPV will be analysed. RESULTS There were 3020 subjects; mean follow-up of 3.7 yrs. Mean age was 63 y and 63% were male. Baseline BPV was measured a mean of 70 days (SD 47) after index event. CV was well-cor-related with SD (r=0.87) and ARV was well-correlated with SD (r=0.91) and CV (r=0.75). BPV was more prevalent in Spanish and Latin American than North American participants (p<0.01). No other baseline characteristics were significantly different among all measures of BPV. No association between time from stroke and BPV was found. There was no association between any measure of BPV with all recurrence of stroke, ischemic stroke, or death (ARV and recur-rent stroke:Q1 REF, Q2 HR 0.68 (95% CI 0.45-0.91), Q3 0.9 (0.7-1.2),Q4 0.87(0.6-1.2). Fur-ther analysis of outcomes with long-term BPV and effects of antihypertensive treatment inter-ventions will be presented. CONCLUSION Within-visit BPV at baseline is not associated with recurrent stroke within this large, well-de-fined cohort of lacunar stroke patients. Further analysis of the SPS3 data, with its extensive follow-up and rigorous methodology for BP measurement will likely elucidate the impact of BPV on stroke recurrence and cognitive outcomes.
Karger_ESC London_2013
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