PS-C28-4: IMPACT OF SYSTOLIC BLOOD PRESSURE ON OUTCOMES IN ACUTE ISCHEMIC STROKE AFTER INTRAVENOUS THROMBOLYSIS: NCVC RT-PA REGISTRY

Abstract

Background: The optimal management of systolic blood pressure (SBP) in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis (IVT) remains unclear. We aimed to clarify the association between SBP parameters, including variability and clinical outcomes in AIS patients who received IVT. Methods: Data of AIS patients receiving intravenous alteplase at 0.6 mg/kg were extracted from the National Cerebral and Cardiovascular Center (NCVC) rt-PA Registry. SBP was measured seven times at admission and within 24 hours every 4 hours after IVT. SBP variabilities included maximum SBP, minimum SBP, mean SBP, standard deviation, coefficient of variation, and successive variation. Outcomes were defined as modified Rankin Scale score 3–6 at 90 days, representing unfavorable outcome, and symptomatic intracranial hemorrhage (SICH) within 36 hours. Results: Among 802 patients (303 women; median age, 76 years; median National Institutes of Health Stroke Scale score, 12), 424 (52.9%) AIS patients had unfavorable outcomes and 16 (2.0%) patients had SICH, respectively. In multivariable analyses, maximum (adjusted odds ratio per 10 mmHg 1.13, 95% confidence interval, 1.04–1.24), minimum (1.27, 1.14–1.42), and mean SBP (1.54, 1.35–1.77) were independently associated with unfavorable outcomes. Conclusions: SBP during the initial 24 hours after intravenous low-dose alteplase was associated with unfavorable outcomes.