Validation of a clinical-genetics score to predict hemorrhagic transformations after rtPA
Por:
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
Publicada:
27 ago 2019
Resumen:
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.
Filiaciones:
Carrera, C:
Univ Autonoma Barcelona, Vall Hebron Res Inst, Neurovasc Res Lab, Barcelona, Spain
Cullell, N:
Fdn Docencia & Recerca Mutua Terrassa, Stroke Pharmacogenom & Genet, Barcelona, Spain
Torres-Aguila, N:
Fdn Docencia & Recerca Mutua Terrassa, Stroke Pharmacogenom & Genet, Barcelona, Spain
Muino, E:
Fdn Docencia & Recerca Mutua Terrassa, Stroke Genom & Genet, Barcelona, Spain
Bustamante, A:
Univ Autonoma Barcelona, Vall Hebron Res Inst, Neurovasc Res Lab, Barcelona, Spain
Davalos, A:
Hosp Badalona Germans Trias & Pujol, Dept Neurosci, Barcelona, Spain
Lopez-Cancio, E:
Hosp Univ Cent Asturias, Stroke Unit, Oviedo, Asturias, Spain
Ribo, M:
Hosp Univ Vall Hebron, Stroke Unit, Barcelona, Spain
Molina, CA:
Hosp Univ Vall Hebron, Stroke Unit, Barcelona, Spain
Giralt-Steinhauer, E:
IMIM Hosp del Mar, Dept Neurol, Neurovasc Res Grp, Barcelona, Spain
Soriano-Tarraga, C:
IMIM Hosp del Mar, Dept Neurol, Neurovasc Res Grp, Barcelona, Spain
Mola-Caminal, M:
IMIM Hosp del Mar, Dept Neurol, Neurovasc Res Grp, Barcelona, Spain
Jimenez-Conde, J:
IMIM Hosp del Mar, Dept Neurol, Neurovasc Res Grp, Barcelona, Spain
Roquer, J:
IMIM Hosp del Mar, Dept Neurol, Neurovasc Res Grp, Barcelona, Spain
Vives-Bauza, C:
Inst Invest Sanitaria Palma, Neurobiol Lab, Barcelona, Spain
Navarro, RD:
Hosp Univ Son Espases, Dept Neurol, Barcelona, Spain
Obach, V:
Hosp Clin Barcelona, Dept Neurol, Barcelona, Spain
Arenillas, JF:
Univ Valladolid, Hosp Clin Univ, Dept Neurol, Barcelona, Spain
Segura, T:
Hosp Univ Albacete, Dept Neurol, Barcelona, Spain
Serrano-Heras, G:
Hosp Univ Albacete, Expt Res Unit, Barcelona, Spain
Marti-Fabregas, J:
IIB St Pau, Hosp Sant Creu & St Pau, Dept Neurol, Barcelona, Spain
Freijo, M:
Hosp Basurto, Dept Neurol, Barcelona, Spain
Cabezas, JA:
IBIS, Virgen del Rocio Hosp, Dept Neurol, Barcelona, Spain
IBIS, Macarena Hosp, Dept Neurol, Barcelona, Spain
Tatlisumak, T:
Univ Gothenburg, Sahlgrenska Acad, Dept Clin Neurosci Neurol, Gothenburg, Sweden
Sahlgrens Univ Hosp, Gothenburg, Sweden
Heitsch, L:
Washington Univ, Sch Med, Div Emergency Med, St Louis, MO USA
Ibanez, L:
Washington Univ, Sch Med, Dept Psychiat, St Louis, MO 63110 USA
Cruchaga, C:
Washington Univ, Sch Med, Dept Psychiat, St Louis, MO 63110 USA
Lee, JM:
Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA
Strbian, D:
Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland
Montaner, J:
Univ Autonoma Barcelona, Vall Hebron Res Inst, Dept Neurol, IBIS,Virgen Rocio Hosp, Barcelona, Spain
Univ Autonoma Barcelona, Vall Hebron Res Inst, Dept Neurol, IBIS,Macarena Hosp, Barcelona, Spain
Fernandez-Cadenas, I:
Hosp Univ Mutua Terrassa, Stroke Pharmacogenom & Genet, Fdn Docencia & Recerca Mutua Terrassa, IIB St Pau, Barcelona, Spain
Havulinna, A:
Inst Mol Med Finland, Helsinki, Finland
Salomaa, V:
Inst Mol Med Finland, Helsinki, Finland
Green Published, Green Accepted
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