Blood Pressure after Endovascular Therapy for Ischemic Stroke (BEST): A Multi-center Prospective Cohort Study
Abstract
Background and Purpose: To identify the specific post-endovascular stroke therapy (EVT) peak systolic blood pressure (SBP) threshold that best discriminates good from bad functional outcomes (a priori hypothesized to be 160 mmHg), we conducted a prospective, multi-center (12 comprehensive stroke centers across the United States), cohort study with a prespecified analysis plan. Methods: Consecutive adult patients treated with EVT for an anterior ischemic stroke were enrolled from 11/2017 to 07/2018. All SBP values within 24 hours post-EVT were recorded. Using Youden’s index, the threshold of peak SBP that best discriminated primary outcome of dichotomized 90-day mRS (0-2 vs. 3-6) was identified. Association of this SBP threshold with the outcomes was quantified using multiple logistic regression. Results: Among 485 enrolled patients [median age 69 (IQR 57,79) years; 51% females], a peak SBP of 158 mmHg was associated with the largest difference in the dichotomous mRS (absolute risk reduction of 19%). Having a peak SBP >158 mmHg resulted in an increased likelihood of mRS 3-6 (OR 2.24 [1.52-3.29], p158 had an increased likelihood of having a bad outcome in unadjusted, but not in adjusted analysis. The observed effect size was similar to prior studies. This finding should undergo further testing in a future randomized trial of goal-targeted post-EVT antihypertensive treatment. .
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 485 participants or records.
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