Validation of a clinical-genetics score to predict hemorrhagic transformations after rtPA

Autor: Carrera, C, Cullell, N, Torres-Aguila, N, Muino, E, Bustamante, A, Davalos, A, Lopez-Cancio, E, Ribo, M, Molina, CA, Giralt-Steinhauer, E, Soriano-Tarraga, C, Mola-Caminal, M, Jimenez-Conde, J, Roquer, J, Vives-Bauza, C, Navarro, RD, Obach, V, Arenillas, JF, Segura, T, Serrano-Heras, G, Marti-Fabregas, J, Freijo, M, Cabezas, JA, Tatlisumak, T, Heitsch, L, Ibanez, L, Cruchaga, C, Lee, JM, Strbian, D, Montaner, J, Fernandez-Cadenas, I, Carcel-Marquez, J, Gonzalez, J, Munoz, L, Cortijo-Garcia, E, Bueno, RM, Havulinna, A, Salomaa, V
Rok vydání: 2019
Zdroj: NEUROLOGY
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
Neurology
r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol
ISSN: 0028-3878
Popis: Objective To validate the Genot-PA score, a clinical-genetic logistic regression score that stratifies the thrombolytic therapy safety, in a new cohort of patients with stroke. Methods We enrolled 1,482 recombinant tissue plasminogen activator (rtPA)-treated patients with stroke in Spain and Finland from 2003 to 2016. Cohorts were analyzed on the basis of ethnicity and therapy: Spanish patients treated with IV rtPA within 4.5 hours of onset (cohort A and B) or rtPA in combination with mechanical thrombectomy within 6 hours of onset (cohort C) and Finnish participants treated with IV rtPA within 4.5 hours of onset (cohort D). The Genot-PA score was calculated, and hemorrhagic transformation (HT) and parenchymal hematoma (PH) risks were determined for each score stratum. Results Genot-PA score was tested in 1,324 (cohort A, n = 726; B, n = 334; C, n = 54; and D, n = 210) patients who had enough information to complete the score. Of these, 213 (16.1%) participants developed HT and 85 (6.4%) developed PH. In cohorts A, B, and D, HT occurrence was predicted by the score (p = 2.02 x 10(-6), p = 0.023, p = 0.033); PH prediction was associated in cohorts A through C (p = 0.012, p = 0.034, p = 5.32 x 10(-4)). Increased frequency of PH events from the lowest to the highest risk group was found (cohort A 4%-15.7%, cohort B 1.5%-18.2%, cohort C 0%-100%). The best odds ratio for PH prediction in the highest-risk group was obtained in cohort A (odds ratio 5.16, 95% confidence interval 1.46-18.08, p = 0.009). Conclusion The Genot-PA score predicts HT in patients with stroke treated with IV rtPA. Moreover, in an exploratory study, the score was associated with PH risk in mechanical thrombectomy-treated patients.
Databáze: OpenAIRE
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