Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study

Research output: Contribution to journalArticle

Eva A. Mistry, Heidi Sucharew, Akshitkumar M. Mistry, Tapan Mehta, Niraj Arora, Amy K. Starosciak, Felipe De Los Rios La Rosa, James Ernest Siegler, Natasha R. Barnhill, Kishan Patel, Salman Assad, Amjad Tarboosh, Katarina Dakay, Sanjana Salwi, Aurora S. Cruz, Jeffrey Wagner, Enzo Fortuny, Alicia Bennett, Robert F. James, Bharathi Jagadeesan & 10 others Christopher Streib, Kristine O'Phelan, Scott E. Kasner, Stewart A. Weber, Rohan Chitale, John Volpi, Stephan Mayer, Shadi Yaghi, Mahesh V. Jayaraman, Pooja Khatri

Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure(SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mm Hg), weconducted a prospective, multicenter, cohort study with a prespecified analysis plan.Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVTwere recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomeswas quantified using multiple logistic regression.Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBPof 158 mm Hg was associated with the largest difference in the dichotomous modified Rankin Scale score (absoluterisk reduction of 19%). Having a peak SBP >158 mm Hg resulted in an increased likelihood of modified Rankin Scalescore 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment forprespecified variables).Conclusions-A peak post-EVT SBP of 158 mmHg was prospectively identified to best discriminate good from badfunctional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, butnot in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testingin a future randomized trial of goal-targeted post-EVT antihypertensive treatment.

Original languageEnglish (US)
Pages (from-to)3449-3455
Number of pages7
JournalStroke
Volume50
Issue number12
DOIs
StatePublished - Dec 1 2019

PMID: 31587660

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Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study. / Mistry, Eva A.; Sucharew, Heidi; Mistry, Akshitkumar M.; Mehta, Tapan; Arora, Niraj; Starosciak, Amy K.; De Los Rios La Rosa, Felipe; Siegler, James Ernest; Barnhill, Natasha R.; Patel, Kishan; Assad, Salman; Tarboosh, Amjad; Dakay, Katarina; Salwi, Sanjana; Cruz, Aurora S.; Wagner, Jeffrey; Fortuny, Enzo; Bennett, Alicia; James, Robert F.; Jagadeesan, Bharathi; Streib, Christopher; O'Phelan, Kristine; Kasner, Scott E.; Weber, Stewart A.; Chitale, Rohan; Volpi, John; Mayer, Stephan; Yaghi, Shadi; Jayaraman, Mahesh V.; Khatri, Pooja.

In: Stroke, Vol. 50, No. 12, 01.12.2019, p. 3449-3455.

Research output: Contribution to journalArticle

Harvard

Mistry, EA, Sucharew, H, Mistry, AM, Mehta, T, Arora, N, Starosciak, AK, De Los Rios La Rosa, F, Siegler, JE, Barnhill, NR, Patel, K, Assad, S, Tarboosh, A, Dakay, K, Salwi, S, Cruz, AS, Wagner, J, Fortuny, E, Bennett, A, James, RF, Jagadeesan, B, Streib, C, O'Phelan, K, Kasner, SE, Weber, SA, Chitale, R, Volpi, J, Mayer, S, Yaghi, S, Jayaraman, MV & Khatri, P 2019, 'Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study' Stroke, vol. 50, no. 12, pp. 3449-3455. https://doi.org/10.1161/STROKEAHA.119.026889

APA

Mistry, E. A., Sucharew, H., Mistry, A. M., Mehta, T., Arora, N., Starosciak, A. K., ... Khatri, P. (2019). Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study. Stroke, 50(12), 3449-3455. https://doi.org/10.1161/STROKEAHA.119.026889

Vancouver

Mistry EA, Sucharew H, Mistry AM, Mehta T, Arora N, Starosciak AK et al. Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study. Stroke. 2019 Dec 1;50(12):3449-3455. https://doi.org/10.1161/STROKEAHA.119.026889

Author

Mistry, Eva A. ; Sucharew, Heidi ; Mistry, Akshitkumar M. ; Mehta, Tapan ; Arora, Niraj ; Starosciak, Amy K. ; De Los Rios La Rosa, Felipe ; Siegler, James Ernest ; Barnhill, Natasha R. ; Patel, Kishan ; Assad, Salman ; Tarboosh, Amjad ; Dakay, Katarina ; Salwi, Sanjana ; Cruz, Aurora S. ; Wagner, Jeffrey ; Fortuny, Enzo ; Bennett, Alicia ; James, Robert F. ; Jagadeesan, Bharathi ; Streib, Christopher ; O'Phelan, Kristine ; Kasner, Scott E. ; Weber, Stewart A. ; Chitale, Rohan ; Volpi, John ; Mayer, Stephan ; Yaghi, Shadi ; Jayaraman, Mahesh V. ; Khatri, Pooja. / Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study. In: Stroke. 2019 ; Vol. 50, No. 12. pp. 3449-3455.

BibTeX

@article{1ebc826048c14941b88cd23d3f549b03,
title = "Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study",
abstract = "Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure(SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mm Hg), weconducted a prospective, multicenter, cohort study with a prespecified analysis plan.Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVTwere recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomeswas quantified using multiple logistic regression.Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51{\%} females), a peak SBPof 158 mm Hg was associated with the largest difference in the dichotomous modified Rankin Scale score (absoluterisk reduction of 19{\%}). Having a peak SBP >158 mm Hg resulted in an increased likelihood of modified Rankin Scalescore 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment forprespecified variables).Conclusions-A peak post-EVT SBP of 158 mmHg was prospectively identified to best discriminate good from badfunctional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, butnot in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testingin a future randomized trial of goal-targeted post-EVT antihypertensive treatment.",
keywords = "Antihypertensive agents, Blood pressure, Brain ischemia, Reperfusion, Retrospective studies",
author = "Mistry, {Eva A.} and Heidi Sucharew and Mistry, {Akshitkumar M.} and Tapan Mehta and Niraj Arora and Starosciak, {Amy K.} and {De Los Rios La Rosa}, Felipe and Siegler, {James Ernest} and Barnhill, {Natasha R.} and Kishan Patel and Salman Assad and Amjad Tarboosh and Katarina Dakay and Sanjana Salwi and Cruz, {Aurora S.} and Jeffrey Wagner and Enzo Fortuny and Alicia Bennett and James, {Robert F.} and Bharathi Jagadeesan and Christopher Streib and Kristine O'Phelan and Kasner, {Scott E.} and Weber, {Stewart A.} and Rohan Chitale and John Volpi and Stephan Mayer and Shadi Yaghi and Jayaraman, {Mahesh V.} and Pooja Khatri",
year = "2019",
month = "12",
day = "1",
doi = "10.1161/STROKEAHA.119.026889",
language = "English (US)",
volume = "50",
pages = "3449--3455",
journal = "Stroke",
issn = "0039-2499",
number = "12",

}

RIS

TY - JOUR

T1 - Blood pressure after endovascular therapy for ischemic stroke (BEST) a multicenter prospective cohort study

AU - Mistry, Eva A.

AU - Sucharew, Heidi

AU - Mistry, Akshitkumar M.

AU - Mehta, Tapan

AU - Arora, Niraj

AU - Starosciak, Amy K.

AU - De Los Rios La Rosa, Felipe

AU - Siegler, James Ernest

AU - Barnhill, Natasha R.

AU - Patel, Kishan

AU - Assad, Salman

AU - Tarboosh, Amjad

AU - Dakay, Katarina

AU - Salwi, Sanjana

AU - Cruz, Aurora S.

AU - Wagner, Jeffrey

AU - Fortuny, Enzo

AU - Bennett, Alicia

AU - James, Robert F.

AU - Jagadeesan, Bharathi

AU - Streib, Christopher

AU - O'Phelan, Kristine

AU - Kasner, Scott E.

AU - Weber, Stewart A.

AU - Chitale, Rohan

AU - Volpi, John

AU - Mayer, Stephan

AU - Yaghi, Shadi

AU - Jayaraman, Mahesh V.

AU - Khatri, Pooja

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure(SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mm Hg), weconducted a prospective, multicenter, cohort study with a prespecified analysis plan.Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVTwere recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomeswas quantified using multiple logistic regression.Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBPof 158 mm Hg was associated with the largest difference in the dichotomous modified Rankin Scale score (absoluterisk reduction of 19%). Having a peak SBP >158 mm Hg resulted in an increased likelihood of modified Rankin Scalescore 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment forprespecified variables).Conclusions-A peak post-EVT SBP of 158 mmHg was prospectively identified to best discriminate good from badfunctional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, butnot in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testingin a future randomized trial of goal-targeted post-EVT antihypertensive treatment.

AB - Background and Purpose-To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure(SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mm Hg), weconducted a prospective, multicenter, cohort study with a prespecified analysis plan.Methods-Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from November 2017to July 2018 at 12 comprehensive stroke centers accross the United States. All SBP values within 24 hours post-EVTwere recorded. Using Youden index, the threshold of peak SBP that best discriminated primary outcome of dichotomized90-day modified Rankin Scale score (0-2 versus 3-6) was identified. Association of this SBP threshold with the outcomeswas quantified using multiple logistic regression.Results-Among 485 enrolled patients (median age, 69 [interquartile range, 57-79] years; 51% females), a peak SBPof 158 mm Hg was associated with the largest difference in the dichotomous modified Rankin Scale score (absoluterisk reduction of 19%). Having a peak SBP >158 mm Hg resulted in an increased likelihood of modified Rankin Scalescore 3 to 6 (odds ratio, 2.24 [1.52-3.29], P<0.01; adjusted odds ratio, 1.29 [0.81-2.06], P=0.28, after adjustment forprespecified variables).Conclusions-A peak post-EVT SBP of 158 mmHg was prospectively identified to best discriminate good from badfunctional outcome. Those with a peak SBP >158 had an increased likelihood of having a bad outcome in unadjusted, butnot in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testingin a future randomized trial of goal-targeted post-EVT antihypertensive treatment.

KW - Antihypertensive agents

KW - Blood pressure

KW - Brain ischemia

KW - Reperfusion

KW - Retrospective studies

UR - http://www.scopus.com/inward/record.url?scp=85075474798&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85075474798&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.119.026889

DO - 10.1161/STROKEAHA.119.026889

M3 - Article

VL - 50

SP - 3449

EP - 3455

JO - Stroke

T2 - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

ER -

ID: 60070577