The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial
Issued Date
2024-01-01
Resource Type
ISSN
17474930
eISSN
17474949
Scopus ID
2-s2.0-85204066529
Pubmed ID
39086232
Journal Title
International Journal of Stroke
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Stroke (2024)
Suggested Citation
Kaveeta C., Alhabli I., Bala F., Horn M., Benali F., Coutts S.B., Zafar A., Bereznyakova O., Khaw A., Khosravani H., Hunter G., Tkach A., Dowlatshahi D., Catanese L., Bogiatzi C., Appireddy R., Buck B.H., Swartz R.H., Sajobi T.T., Almekhlafi M., Demchuk A.M., Ganesh A., Menon B., Singh N. The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial. International Journal of Stroke (2024). doi:10.1177/17474930241273561 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101329
Title
The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial
Author's Affiliation
Siriraj Hospital
L’École de médecine
Rady Faculty of Health Sciences
Kelowna General Hospital
London Health Sciences Centre
Sunnybrook Health Sciences Centre
Queen's University, School of Medicine
University of Alberta, Faculty of Medicine and Dentistry
St. Michael's Hospital, Toronto
Centre Hospitalier Regional et Universitaire de Tours
University of Saskatchewan
University of Montreal
Hamilton Health Sciences
Cumming School of Medicine
L’École de médecine
Rady Faculty of Health Sciences
Kelowna General Hospital
London Health Sciences Centre
Sunnybrook Health Sciences Centre
Queen's University, School of Medicine
University of Alberta, Faculty of Medicine and Dentistry
St. Michael's Hospital, Toronto
Centre Hospitalier Regional et Universitaire de Tours
University of Saskatchewan
University of Montreal
Hamilton Health Sciences
Cumming School of Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
Background: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication. Aims: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase. Methods: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0–1, mRS 0–2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0–4 vs 5–7 vs 8–10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity. Results: Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65–84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17–19)) with anterior circulation stroke were included. mRS 0–1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0–4, 5–7, and 8–10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0–1 and mRS 0–2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0–1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes. Conclusion: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase. Data access statement: Data shall made available on reasonable request from the PI (BMM).