Evidence map›Paper›PMID 33040702›Full record

Observational studyStroke2020

Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment.

Sophie A van den Berg, Simone M Uniken Venema, Maxim J H L Mulder, Kilian M Treurniet, Noor Samuels, Hester F Lingsma, Robert-Jan B Goldhoorn, Ivo G H Jansen, Jonathan M Coutinho, Bob Roozenbeek and 5 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.

0numbers the graph read from it
0cells of the map it votes in
27citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

27 citing papers in PubMed.

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  19. Blood Pressure Goals in Acute Stroke.American journal of hypertension · 2022
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Sophie A van den Berg *Department of Neurology (S.A.v.d.B., J.M.C., Y.B.W.E.M.R., P.J.N.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
Simone M Uniken Venema *Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands (S.M.U.V., H.B.v.d.W.).
Maxim J H L MulderDepartment of Neurology (M.J.H.L.M., B.R., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Kilian M TreurnietDepartment of Radiology (K.M.T., I.G.H.J.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
Noor SamuelsDepartment of Public Health (N.S., H.F.L.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Hester F LingsmaDepartment of Public Health (N.S., H.F.L.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Robert-Jan B GoldhoornDepartment of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands (R.-J.B.G.).
Ivo G H JansenDepartment of Radiology (K.M.T., I.G.H.J.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
Jonathan M CoutinhoDepartment of Neurology (S.A.v.d.B., J.M.C., Y.B.W.E.M.R., P.J.N.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
Bob RoozenbeekDepartment of Neurology (M.J.H.L.M., B.R., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Diederik W J DippelDepartment of Neurology (M.J.H.L.M., B.R., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
Yvo B W E M RoosDepartment of Neurology (S.A.v.d.B., J.M.C., Y.B.W.E.M.R., P.J.N.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
H Bart van der WorpDepartment of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands (S.M.U.V., H.B.v.d.W.).
Paul J NederkoornDepartment of Neurology (S.A.v.d.B., J.M.C., Y.B.W.E.M.R., P.J.N.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
MR CLEAN Registry Investigators†

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

background and purposeOptimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT.

methodsWe used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP.

resultsWe included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar.

conclusionsIn patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.

Indexed as

Blood PressureEndovascular ProceduresMortalityAgedAged, 80 and overFemaleFunctional StatusHospitalizationHumansHypertensionIntracranial HemorrhagesIschemic StrokeLinear ModelsLogistic ModelsMaleMiddle Agedblood pressurehypertensionischemic strokereperfusionthrombectomy

Identifiers

PMID33040702
PMCPMC7587243

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.