Early infarct growth predicts long-term clinical outcome after thrombolysis

Kyung-Hee Cho, Sun U. Kwon, Deok Hee Lee, Woohyun Shim, Choonggon Choi, Sang Joon Kim, Dae Chul Suh, Jong S. Kim, Dong Wha Kang

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.

Original languageEnglish
Pages (from-to)99-103
Number of pages5
JournalJournal of the Neurological Sciences
Volume316
Issue number1-2
DOIs
Publication statusPublished - 2012 May 15

Fingerprint

Growth
Stroke
Odds Ratio
National Institutes of Health (U.S.)
Confidence Intervals
Biomarkers
Middle Cerebral Artery Infarction
Urokinase-Type Plasminogen Activator
Tissue Plasminogen Activator
ROC Curve
Multivariate Analysis

Keywords

  • Acute stroke
  • Diffusion-weighted imaging
  • MRI
  • Outcome
  • Thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Early infarct growth predicts long-term clinical outcome after thrombolysis. / Cho, Kyung-Hee; Kwon, Sun U.; Lee, Deok Hee; Shim, Woohyun; Choi, Choonggon; Kim, Sang Joon; Suh, Dae Chul; Kim, Jong S.; Kang, Dong Wha.

In: Journal of the Neurological Sciences, Vol. 316, No. 1-2, 15.05.2012, p. 99-103.

Research output: Contribution to journalArticle

Cho, K-H, Kwon, SU, Lee, DH, Shim, W, Choi, C, Kim, SJ, Suh, DC, Kim, JS & Kang, DW 2012, 'Early infarct growth predicts long-term clinical outcome after thrombolysis', Journal of the Neurological Sciences, vol. 316, no. 1-2, pp. 99-103. https://doi.org/10.1016/j.jns.2012.01.015
Cho, Kyung-Hee ; Kwon, Sun U. ; Lee, Deok Hee ; Shim, Woohyun ; Choi, Choonggon ; Kim, Sang Joon ; Suh, Dae Chul ; Kim, Jong S. ; Kang, Dong Wha. / Early infarct growth predicts long-term clinical outcome after thrombolysis. In: Journal of the Neurological Sciences. 2012 ; Vol. 316, No. 1-2. pp. 99-103.
@article{682ae4260aae45ca84559ba0a1f840ad,
title = "Early infarct growth predicts long-term clinical outcome after thrombolysis",
abstract = "Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7{\%}) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95{\%} confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95{\%} CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95{\%} CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.",
keywords = "Acute stroke, Diffusion-weighted imaging, MRI, Outcome, Thrombolysis",
author = "Kyung-Hee Cho and Kwon, {Sun U.} and Lee, {Deok Hee} and Woohyun Shim and Choonggon Choi and Kim, {Sang Joon} and Suh, {Dae Chul} and Kim, {Jong S.} and Kang, {Dong Wha}",
year = "2012",
month = "5",
day = "15",
doi = "10.1016/j.jns.2012.01.015",
language = "English",
volume = "316",
pages = "99--103",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",
number = "1-2",

}

TY - JOUR

T1 - Early infarct growth predicts long-term clinical outcome after thrombolysis

AU - Cho, Kyung-Hee

AU - Kwon, Sun U.

AU - Lee, Deok Hee

AU - Shim, Woohyun

AU - Choi, Choonggon

AU - Kim, Sang Joon

AU - Suh, Dae Chul

AU - Kim, Jong S.

AU - Kang, Dong Wha

PY - 2012/5/15

Y1 - 2012/5/15

N2 - Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.

AB - Background: Ischemic lesion growth may be a surrogate marker of clinical outcome, but no such interrelationship after thrombolysis has yet been determined. We evaluated the association between early infarct growth on diffusion-weighted imaging (DWI) and long-term clinical outcome after thrombolysis. Methods: We retrospectively reviewed outcomes in patients with acute middle cerebral artery territory stroke who had been treated with intravenous tissue plasminogen activator or intra-arterial urokinase. DWI lesion volumes were measured at baseline and within 7 days, and the difference was calculated. Clinical outcome was evaluated using the modified Rankin Scale (mRS) at 3 months. Good and poor clinical outcomes were defined as: a) mRS 0-1 vs. mRS 2-6, b) mRS 0-2 vs. mRS 3-6, and c) responder analysis which was influenced by the baseline National Institutes of Health Stroke Scale (NIHSS) scores: good and poor outcomes were defined as mRS 0 vs. mRS 1-6 if the baseline NIHSS score was < 8, mRS 0-1 vs. mRS 2-6 if the NIHSS score was 8-14, and mRS 0-2 vs. mRS 3-6 if the NIHSS score was > 14. The relationship between the ischemic lesion volume change and clinical outcome was explored. The cut-off value of infarct growth predicting long-term outcome was estimated using receiver operating characteristic analysis. Results: Of the 81 patients included, 67 (82.7%) showed lesion growth, and absolute growth was significantly related to poor outcomes (P < 0.001 all for mRS 2-6, mRS 3-6, and responder analysis). Multivariate analysis showed that absolute lesion growth was an independent predictor of poor outcome, defined as mRS 2-6 (P = 0.002; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10), mRS 3-6 (P = 0.001; OR, 1.06; 95% CI, 1.02-1.10), and poor outcome by responder analysis (P = 0.001; OR, 1.06; 95% CI, 1.03-1.10). The cut-off values of lesion growth that discriminated between good and poor outcomes were 14.11 cm3 for mRS 2-6; 15.87 cm 3 for mRS 3-6; and 14.11 cm3 in responder analysis. Conclusions: Early DWI lesion growth is an independent predictor of poor outcome after thrombolysis and may serve a potential surrogate marker of clinical outcome in acute stroke trials.

KW - Acute stroke

KW - Diffusion-weighted imaging

KW - MRI

KW - Outcome

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=84862789540&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862789540&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2012.01.015

DO - 10.1016/j.jns.2012.01.015

M3 - Article

VL - 316

SP - 99

EP - 103

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

IS - 1-2

ER -