Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study
Background This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated...
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2024-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| author | Shoujiang You Yanan Wang Xia Wang Toshiki Maeda Menglu Ouyang Qiao Han Qiang Li Lili Song Yang Zhao Chen Chen Candice Delcourt Xinwen Ren Cheryl Carcel Zien Zhou Yongjun Cao Chun‐Feng Liu Danni Zheng Hisatomi Arima Thompson G. Robinson Xiaoying Chen Richard I. Lindley John Chalmers Craig S. Anderson |
| author_facet | Shoujiang You Yanan Wang Xia Wang Toshiki Maeda Menglu Ouyang Qiao Han Qiang Li Lili Song Yang Zhao Chen Chen Candice Delcourt Xinwen Ren Cheryl Carcel Zien Zhou Yongjun Cao Chun‐Feng Liu Danni Zheng Hisatomi Arima Thompson G. Robinson Xiaoying Chen Richard I. Lindley John Chalmers Craig S. Anderson |
| author_sort | Shoujiang You |
| collection | DOAJ |
| description | Background This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods and Results ENCHANTED was an international, multicenter, 2×2 quasifactorial, prospective, randomized open trial of low‐dose versus standard‐dose intravenous alteplase and intensive versus guideline‐recommended blood pressure lowering in thrombolysis‐eligible patients with acute ischemic stroke. Absolute (baseline minus 24 hours) and percentage (absolute change/baseline × 100) changes in NIHSS scores were calculated. Receiver operating characteristic curve analyses assessed performance of different NIHSS measurements on 90‐day favorable functional recovery (modified Rankin Scale [mRS] score 0–2) and excellent functional recovery (mRS score 0–1). Youden index was used to identify optimal predictor cutoff points. A total of 4410 patients in the ENCHANTED trial were enrolled. The 24‐hour NIHSS score had the highest discriminative ability for predicting favorable 90‐day functional recovery (mRS score 0–2; area under the curve 0.866 versus 0.755, 0.689, 0.764; P<0.001) than baseline, absolute, and percentage change of NIHSS score, respectively. The optimal cutoff point of 24‐hour NIHSS score for predicting favorable functional recovery was ≤4 (sensitivity 66.5%, specificity 87.1%, adjusted odds ratio, 9.44 [95% CI, 7.77–11.48]). The 24‐hour NIHSS score (≤3) was the best predictor of 90‐day excellent functional recovery (mRS score 0–1). Findings were consistent across subgroups, including sex, race, baseline NIHSS score, stroke subtype, and age. Conclusions In thrombolysis‐eligible patients with acute ischemic stroke, 24‐hour NIHSS score (optimal cutpoint of 4) is the strongest predictor of 90‐day functional recovery over baseline and early change of NIHSS score. Registration URL: https://clinicaltrials.gov. Unique Identifier: NCT01422616. |
| format | Article |
| id | doaj-art-895d69a96a2f47cfac709838db81f26d |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-09-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-895d69a96a2f47cfac709838db81f26d2024-11-28T12:39:09ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-09-01131810.1161/JAHA.124.036109Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED StudyShoujiang You0Yanan Wang1Xia Wang2Toshiki Maeda3Menglu Ouyang4Qiao Han5Qiang Li6Lili Song7Yang Zhao8Chen Chen9Candice Delcourt10Xinwen Ren11Cheryl Carcel12Zien Zhou13Yongjun Cao14Chun‐Feng Liu15Danni Zheng16Hisatomi Arima17Thompson G. Robinson18Xiaoying Chen19Richard I. Lindley20John Chalmers21Craig S. Anderson22Department of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou ChinaDepartment of Neurology, West China Hospital Sichuan University Chengdu Sichuan ChinaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaDepartment of Neurology Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine Suzhou ChinaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaDepartment of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou ChinaDepartment of Neurology and Clinical Research Center of Neurological Disease The Second Affiliated Hospital of SooChow University Suzhou ChinaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaDepartment of Preventive Medicine and Public Health Fukuoka University Fukuoka JapanDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre University of Leicester Leicester UKThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaThe George Institute for Global Health, Faculty of Medicine University of New South Wales Sydney NSW AustraliaBackground This study was conducted to determine optimal predictive ability of National Institutes of Health Stroke Scale (NIHSS) measurements at baseline, 24 hours, and change from baseline to 24 hours after thrombolysis on functional recovery in patients with acute ischemic stroke who participated in the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods and Results ENCHANTED was an international, multicenter, 2×2 quasifactorial, prospective, randomized open trial of low‐dose versus standard‐dose intravenous alteplase and intensive versus guideline‐recommended blood pressure lowering in thrombolysis‐eligible patients with acute ischemic stroke. Absolute (baseline minus 24 hours) and percentage (absolute change/baseline × 100) changes in NIHSS scores were calculated. Receiver operating characteristic curve analyses assessed performance of different NIHSS measurements on 90‐day favorable functional recovery (modified Rankin Scale [mRS] score 0–2) and excellent functional recovery (mRS score 0–1). Youden index was used to identify optimal predictor cutoff points. A total of 4410 patients in the ENCHANTED trial were enrolled. The 24‐hour NIHSS score had the highest discriminative ability for predicting favorable 90‐day functional recovery (mRS score 0–2; area under the curve 0.866 versus 0.755, 0.689, 0.764; P<0.001) than baseline, absolute, and percentage change of NIHSS score, respectively. The optimal cutoff point of 24‐hour NIHSS score for predicting favorable functional recovery was ≤4 (sensitivity 66.5%, specificity 87.1%, adjusted odds ratio, 9.44 [95% CI, 7.77–11.48]). The 24‐hour NIHSS score (≤3) was the best predictor of 90‐day excellent functional recovery (mRS score 0–1). Findings were consistent across subgroups, including sex, race, baseline NIHSS score, stroke subtype, and age. Conclusions In thrombolysis‐eligible patients with acute ischemic stroke, 24‐hour NIHSS score (optimal cutpoint of 4) is the strongest predictor of 90‐day functional recovery over baseline and early change of NIHSS score. Registration URL: https://clinicaltrials.gov. Unique Identifier: NCT01422616.https://www.ahajournals.org/doi/10.1161/JAHA.124.036109ENCHANTEDischemic strokeNIHSS scorepredictorthrombolysis |
| spellingShingle | Shoujiang You Yanan Wang Xia Wang Toshiki Maeda Menglu Ouyang Qiao Han Qiang Li Lili Song Yang Zhao Chen Chen Candice Delcourt Xinwen Ren Cheryl Carcel Zien Zhou Yongjun Cao Chun‐Feng Liu Danni Zheng Hisatomi Arima Thompson G. Robinson Xiaoying Chen Richard I. Lindley John Chalmers Craig S. Anderson Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ENCHANTED ischemic stroke NIHSS score predictor thrombolysis |
| title | Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study |
| title_full | Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study |
| title_fullStr | Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study |
| title_full_unstemmed | Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study |
| title_short | Twenty‐Four‐Hour Post‐Thrombolysis NIHSS Score As the Strongest Prognostic Predictor After Acute Ischemic Stroke: ENCHANTED Study |
| title_sort | twenty four hour post thrombolysis nihss score as the strongest prognostic predictor after acute ischemic stroke enchanted study |
| topic | ENCHANTED ischemic stroke NIHSS score predictor thrombolysis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036109 |
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