Impact of core infarct at baseline on clinical outcome in patients undergoing reperfusion therapies.
| Abstract: |
- OBJECTIVES: Volume of infarct core at baseline may have an impact on functional outcome in acute ischemic stroke patients treated with reperfusion therapies. Moreover it has been hypothesized that such therapies have no benefit beyond some core volume threshold. We systematically reviewed the literature for evidence that large infarct core at baseline has an effect on stroke prognosis in patients undergoing reperfusion therapies.
- MATERIALS AND METHODS: We searched for articles published between December 1995 and November 2016. We included studies evaluating the impact of a large infarct core at baseline on good clinical outcome and fatality in patients with an acute ischemic stroke undergoing reperfusion therapies. We extracted data to calculate the odds ratio of each outcome and to test for heterogeneity. We also test for an interaction between treatment and clinical outcome using data from randomised-controlled trials.
- RESULTS: We included 24 studies. Large ischemic core at admission was negatively associated with good clinical outcome (OR 0.22 [CI 95% 0.14, 0.34]) and increased the risk of fatal outcome at three months (OR 4.57 [CI 95% 2.82, 7.41]). We found no evidence of a treatment interaction on clinical outcome between patients with large versus small infarct core using randomised-controlled trial data (p value=0.1835).
- CONCLUSIONS: Large ischemic core at admission increases the risk of both poor functional outcome and mortality in patients with an acute ischaemic stroke treated with reperfusion therapies. Nevertheless these therapies have a beneficial effect even when a large core is present.
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- Systematic review
- Meta-analysis
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