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London, United Kingdom 2013 7 Acute stroke: emergency management, stroke units and complications A 9:30 - 9:40 Effects of candesartan on blood pressure variability in acute stroke: Is it important for prognosis? Results from the Scandinavian Candesartan Acute Stroke Trial E.C. Sandset1, S.E. Kjeldsen2, P.M. Rothwell3, P- Bath4, E. Berge5 Oslo Unversity Hosptial, Oslo, NORWAY1,Oslo University Hospital, Oslo, NORWAY2, Uni-versity of Oxford, Oxford, UNITED KINGDOM3, University of Nottingham, Nottingham, UNITED KINGDOM4, Oslo University Hospital, Oslo, NORWAY5 Background The Scandinavian Candesartan Acute Stroke Trial (SCAST) found no benefits of blood pres-sure lowering treatment with the angiotensin receptor blocker candesartan in acute stroke. In the present analysis we have assessed the effect of candesartan on systolic blood pressure (SBP) variability in the first week following stroke, and the effect of blood pressure variability on prognosis. Methods SCAST was a multicentre, randomised, placebo-controlled trial of candesartan in acute stroke. The trial enrolled 2,029 patients presenting within 30 hours of acute ischaemic or haemorrhagic stroke and with SBP >/=140 mm Hg. Treatment was administered for 7 days, and blood pres-sure was measured once daily during this period. SBP-variability was expressed as the standard deviation of all available measurements from baseline to day 7 (SBP-SD). We analysed the effect of treatment with candesartan on blood pressure variability. We also studied the effect of blood pressure variability on functional outcome at 6 months (mRS) and on vascular events (vascular death, myocardial infarction or stroke) during the same period. All analyses have been adjusted for age, Scandinavian Stroke Scale score, trial treatment and mean SBP. Results Patients treated with candesartan had significantly higher SBP-SD as compared with patients in the placebo group (p=<0.001). Blood pressure variability was a significant predictor of poor functional outcome at 6 months (OR, 95% CI: 1.02, 1.00 – 1.04), but not for vascular events (OR, 95% CI: 1.01, 0.99 – 1.04). Figure 1 shows the results of the adjusted analysis of SBP-SD divided into quartiles, using quartile 1 as the reference category. Conclusion Candesartan increases blood pressure variability in the acute phase of stroke, which seems to be a predictor of poor outcome. The effect of reducing blood pressure variability in acute stroke should be assessed in future research. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 91 6 Acute stroke: emergency management, stroke units and complications A 9:20 - 9:30 Prehospital validation of a neurological scale to predict a large vessel occlusion in patients with an acute ischemic stroke D. Carrera1, N. Pérez de la Ossa2, M. Gorchs3, M. Querol4, M. Gomis5, L. Dorado6, E. López-Cancio7, M. Hernández8, M. Millán9, V. Chicharro10, X. Jiménez11, X. Escalada12, A. Dávalos13 Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN1,Stroke Unit. Neuroscience Department. Hospital Universitari Germans Tri-as i Pujol., Badalona, SPAIN2, Sistema d’Emergències Mèdiques, Barcelona, SPAIN3, Sistema d’Emergències Mèdiques, Barcelona, SPAIN4, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN5, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN6, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN7, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN8, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN9, Grup La Pau, Badalona, SPAIN10, Sistema d’Emergències Mèdiques, Barcelona, SPAIN11, Sistema d’Emergències Mèdiques, Barcelona, SPAIN12, Stroke Unit. Neuroscience Department. Hospital Universitari Germans Trias i Pujol., Badalona, SPAIN13 Background Our aim was to validate in the prehospital setting a neurological scale that helps to identify patients with an acute ischemic stroke and a large vessel occlusion (LVO): the Rapid Arterial oCclusion Evaluation (RACE). Methods The RACE includes those items from the Na-tional Institutes of Health Stroke Scale (NIHSS) which are more associated with the presence of a LVO, according to a retrospective study of 654 stroke patients admitted to our Stroke Unit: gaze palsy (0-1), facial palsy (0-2), brachial palsy (0-2), crural palsy (0-2) and aphasia/agnosia (0-2). After a training program and over a 18-months period, prehospital personnel used it to assess Stroke Code patients. Results 552 patients were transferred as a Stroke Code and 263 of them (48%) were evaluated with the RACE. The existence of a LVO was assessed in all pa-tients at hospital admission using transcranial duplex or cerebral angiography, being confirmed in 32% of them. The RACE showed a good correlation with the NIHSS (r = 0.81, p < 0.001) and its accuracy in identifying patients with a LVO was high (AUC 0.82). A score ≥ 4 predict-ed the presence of a LVO with sensitivity = 0.86, specificity = 0.63, positive predictive value = 0.53 and negative predictive value = 0.90. Conclusion Using this novel scale in the field, pre-hospital personnel can identify stroke patients harboring a LVO with high sensitivity although moderate specificity. Thus, the RACE could be used to select and route those patients to a com-prehensive stroke center, with availability of endovascular procedures.


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