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Published on: February 17, 2013
Admission Blood Pressure Modifies the Perfusion Collateral Impairment Score and Outcome in Anterior Circulation Large
Shankar Biswas1, Hamza Adel Salim2, Derek A Tsang2
1From the Department of Internal Medicine (S.B.), Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine; Department of Neuroradiology (H.A.S., A.C.), Neurosurgery (R.X.), Neurology (R.L.), Radiology (V.S.Y.), Johns Hopkins University School of Medicine (D.A.T., K.L.), Baltimore, MD, USA; Department of Neuroradiology (D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA; Department of Neuroradiology (A.S.), University of Cincinnati, Cincinnati, OH, USA; Department of Neuroscience (V.V.), Renaissance School of Medicine, SUNY Stony Brook, Stony Brook, NY, USA; Department of Neuroradiology (G.S.), University of Michigan (Michigan Medicine), Ann Arbor, MI, USA; Department of Interventional Neuroradiology (A.G.), Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology and Neurosurgery (A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology (F.K.H.), University of Hawaii, Honolulu, HI, USA; Stanford Stroke Center, Department of Neurology (G.W.A.), Radiology (J.J. H.), Stanford University School of Medicine, Stanford, CA, USA and Department of Radiology (T.D.F.), University Hospitals Münster, Münster, Germany. Sb740927@gmail.com.
Insights
Admission blood pressure may influence the outcome of large vessel occlusion (LVO) stroke patients treated with the Perfusion Collateral Impairment Score (PCIS). Higher blood pressure may worsen outcomes, particularly in severe cases, suggesting blood pressure enhances PCIS interpretation.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- The Perfusion Collateral Impairment Score (PCIS) is a perfusion metric used in large vessel occlusion (LVO) stroke.
- Its correlation with 90-day outcomes is established, but the role of admission blood pressure as an interaction factor is unclear.
Purpose of the Study:
- To investigate whether admission blood pressure modifies the association between PCIS and 90-day outcomes in patients with acute anterior circulation LVO.
- To determine if diastolic blood pressure (DBP) or mean arterial pressure (MAP) interact with PCIS in predicting stroke outcomes.
Main Methods:
- A cohort of 245 patients with acute anterior circulation LVO and NIHSS > 5 was analyzed.
- Admission DBP and MAP were averaged from measurements within the first 2 hours.
- The interaction between PCIS and blood pressure on 90-day outcome (mRS 3-6) was tested using adjusted models.
Main Results:
- The interaction between PCIS and blood pressure was most significant for severe outcomes (mRS 4-6), with higher DBP and MAP associated with worse outcomes.
- While directionally consistent, the primary interaction at mRS 3-6 did not reach statistical significance after adjustment and correction for multiple comparisons.
- Higher admission DBP widened the predicted probability difference between low and high PCIS from 11% to 39%.
Conclusions:
- The primary interaction between PCIS and admission blood pressure on 90-day outcome in LVO stroke did not reach significance.
- However, admission blood pressure may modify the association of PCIS with outcomes, especially in severe cases.
- Further prospective, externally validated studies are needed before clinical translation of these findings.
Background And Purpose:
The Perfusion Collateral Impairment Score (PCIS), a 3-component perfusion metric, is an ordinal composite correlated with 90-day outcome in large vessel occlusion (LVO) stroke. It remains unclear whether admission blood pressure is an interaction factor.
Materials And Methods:
We studied 245 patients with acute anterior circulation LVO and an admission NIHSS > 5, from two hospitals within one health system. We calculated average admission diastolic blood pressure (DBP) and mean arterial pressure (MAP) from a minimum of three measurements taken within the first 2 hours. The PCIS interaction with DBP or MAP on 90-day outcome (mRS 3-6) was tested in an adjusted model using the likelihood ratio test.
Results:
One hundred thirty-eight (56.3%) patients had an unfavorable outcome (mRS 3-6). The interaction was most apparent at the severe-disability end (mRS 4-6), with higher admission DBP and MAP producing a steeper slope relating PCIS to outcome (DBP OR, 1.54; 95% CI, 1.07-2.21; MAP OR, 1.60; 95% CI, 1.11-2.32). Odds ratios were above 1.0 at every outcome level, and the predicted-probability difference between low and high PCIS widened from 11% to 39% with increasing DBP. At the primary threshold (mRS 3-6) the interaction was directionally consistent but did not reach significance (DBP OR, 1.40; P = .048; MAP OR, 1.34; P = .09) and did not survive correction for multiple comparisons. No interaction was seen between PCIS and NIHSS.
Conclusions:
The primary interaction at mRS 3-6 did not reach significance after adjustment. Nonetheless, the association of PCIS with 90-day outcome after anterior circulation LVO stroke may be modified by admission blood pressure, especially in the subset with severe outcomes, independent of admission clinical deficit. Admission pressure may enhance interpretation of PCIS rather than act as a predictor itself, and the relationship requires prospective, externally validated study before clinical translation.
