Evidence map›Paper›PMID 37290930›Full record

Trial reportStroke and vascular neurology2024

Prehospital transdermal glyceryl trinitrate for ultra-acute ischaemic stroke: data from the RIGHT-2 randomised sham-controlled ambulance trial.

Jason Philip Appleton, Lisa J Woodhouse, Craig S Anderson, Sandeep Ankolekar, Lesley Cala, Mark Dixon, Timothy J England, Kailash Krishnan, Grant Mair, Keith W Muir and 13 more

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke and vascular neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.7field-weighted citation impact, top 15% of its field
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

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Effect of prior antiplatelet therapy on recurrence in patients with acute cerebral ischaemia: data from the triple antiplatelets for reducing dependency after ischaemic stroke (TARDIS) randomised trial.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
    Trial
  3. Trial
  4. Trial
  5. Trial
  6. Article
  7. The hazards of chasing subgroups in neutral stroke trials.Neurological research and practice · 2025
    Review
  8. Article
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

23 authors at 16 institutions in 5 countries.

Jason Philip Appleton *Stroke, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.ORCID 0000-0002-2604-4410
Lisa J Woodhouse *Stroke Trials Unit, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK.ORCID 0000-0002-4472-1999
Craig S AndersonFaculty of Medicine, The George Institute for Global Health, Sydney, New South Wales, Australia.
Sandeep AnkolekarDepartment of Neurology, King's College Hospital NHS Foundation Trust, London, UK.
Lesley CalaFaculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
Mark DixonStroke Trials Unit, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK.
Timothy J EnglandStroke Trials Unit, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK.
Kailash KrishnanStroke, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.ORCID 0000-0002-6486-3783
Grant MairCentre for Clinical Brain Sciences, Dementia Research Institute, Univeristy of Edinburgh, Edinburgh, UK.
Keith W MuirInstitute of Neurology and Psychology, University of Glasgow, Glasgow, UK.
John PotterBob Champion Research and Education Building, University of East Anglia, Norwich, UK.
Christopher I PriceInstitute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
Marc RandallDepartment of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Thompson G RobinsonDepartment of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
Christine RoffeStroke Research in Stoke, Institute for Science and Technology in Medicine, Keele University, Stoke-on-Trent, UK.
Else C SandsetDepartment of Neurology, Oslo University Hospital, Oslo, Norway.
Jeffrey L SaverDepartment of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, UCLA, Los Angeles, California, USA.
Angela ShoneResearch and Graduate Services, University of Nottingham, Nottingham, UK.
Aloysius Niroshan SiriwardenaEast Midlands Ambulance Service NHS Trust, Nottingham, UK.
Joanna M WardlawCentre for Clinical Brain Sciences, Dementia Research Institute, Univeristy of Edinburgh, Edinburgh, UK.ORCID 0000-0002-9812-6642
Nikola SpriggStroke Trials Unit, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK.
Philip M BathStroke Trials Unit, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK philip.bath@nottingham.ac.uk.ORCID 0000-0003-2734-5132
RIGHT-2 Investigators
University of Nottingham · GBNottingham University Hospitals NHS Trust · GBUK Dementia Research Institute · GBEast Midlands Ambulance Service NHS Trust · GBKeele University · GBKing's College Hospital NHS Foundation Trust · GBLeeds Teaching Hospitals NHS Trust · GBNewcastle University · GBOslo University Hospital · NOPeking University · CNThe University of Western Australia · AUUniversity Hospitals Birmingham NHS Foundation Trust · GBUniversity of California, Los Angeles · USUniversity of East Anglia · GBUniversity of Glasgow · GBUniversity of Leicester · GB

Funding

British Heart Foundation CS/14/4/30972
6 · The paper itself

Abstract

backgroundThe effect of transdermal glyceryl trinitrate (GTN, a nitrovasodilator) on clinical outcome when administered before hospital admission in suspected stroke patients is unclear. Here, we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2).

methodsRIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4 hours of onset. The primary outcome was a shift in scores on the modified Rankin scale (mRS) at day 90. Secondary outcomes included death; a global analysis (Wei-Lachin test) containing Barthel Index, EuroQol-5D, mRS, telephone interview for cognitive status-modified and Zung depression scale; and neuroimaging-determined 'brain frailty' markers. Data were reported as n (%), mean (SD), median [IQR], adjusted common OR (acOR), mean difference or Mann-Whitney difference (MWD) with 95% CI.

results597 of 1149 (52%) patients had a final diagnosis of ischaemic stroke; age 75 (12) years, premorbid mRS>2 107 (18%), Glasgow Coma Scale 14 (2) and time from onset to randomisation 67 [45, 108] min. Neuroimaging 'brain frailty' was common: median score 2 [2, 3] (range 0-3). At day 90, GTN did not influence the primary outcome (acOR for increased disability 1.15, 95% CI 0.85 to 1.54), death or global analysis (MWD 0.00, 95% CI -0.10 to 0.09). In subgroup analyses, there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1 hour of symptom onset and in those with more severe stroke.

conclusionsIn patients who had an ischaemic stroke, ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital trials.

Indexed as

Brain IschemiaFrailtyHypertensionIschemic StrokeStrokeAgedAmbulancesHumansNitroglycerinNitroglycerinBlood PressureCerebral InfarctionClinical TrialStroke

Identifiers

PMID37290930
PMCPMC10956104
OpenAlexW4379967487

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.