BACKGROUND AND PURPOSE: The prognostic significance of subarachnoid extension of intracerebral hemorrhage was determined in the INTEnsive blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT2) study. METHODS: INTERACT2 was an open randomized controlled trial of early intensive compared with guideline-recommended blood pressure lowering in patients with elevated systolic blood pressure within 6 hours of intracerebral hemorrhage. Independent predictors of death or major disability (scores 3-6 on the modified Rankin Scale) at 90 days were analyzed in logistic regression models. RESULTS: Of 2582 participants, 192 (7%) had subarachnoid extension, which was associated with larger hematoma volumes (P<0.0001) and higher National Institute of Health Stroke Scale score (P<0.0001). Subarachnoid extension predicted death or major disability at 90 days (71% versus 53%; unadjusted odds ratio, 2.25; 95% confidence interval, 1.63-3.10; P<0.0001). The association remained significant after adjusting for age, region, lipid-lowering therapy, systolic blood pressure, glucose, location of hematoma, intraventricular extension, and randomized treatment (odds ratio, 2.17; 95% confidence interval, 1.50-3.14; P<0.0001), but not after further adjustment for baseline hematoma volume (P=0.62). CONCLUSIONS: Subarachnoid extension of intracerebral hemorrhage is associated with poor prognosis, which is determined by a larger volume of the underlying intraparenchymal hematoma. CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
AD - From the Department of Neurology (G.C.) and Department of Cardiology (P.Z.), Xuzhou Central Hospital, Jiangsu, China; The George Institute for Global Health, University of Sydney, Sydney, Australia (G.C., H.A., G.W., E.H., C.D., L.S., J.Y., X.W., Q.L., X.C., J.C., C.A.); Department of Neurology, Hebei Yutian Hospital, Tang Shan, China (G.W.); Department of Neurology, Mayo Clinic, Rochester, MN (A.A.R.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom (T.R.); Department of Neurology, Universite Paris Diderot-Sorbonne Paris Cite, Paris, France (C.S.); Department of Neurology, Peking University First Hospital, Beijing, China (Y.H.); Department of Neurology, Shanghai 85th Hospital of PLA, Shanghai, China (L.S.); and Department of Neurology, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing, China (J.Y.). AN - 24149007 BT - Stroke DP - NLM ET - 2013/10/24 J2 - LA - Eng N1 - Chen, GuofangBACKGROUND AND PURPOSE: The prognostic significance of subarachnoid extension of intracerebral hemorrhage was determined in the INTEnsive blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT2) study. METHODS: INTERACT2 was an open randomized controlled trial of early intensive compared with guideline-recommended blood pressure lowering in patients with elevated systolic blood pressure within 6 hours of intracerebral hemorrhage. Independent predictors of death or major disability (scores 3-6 on the modified Rankin Scale) at 90 days were analyzed in logistic regression models. RESULTS: Of 2582 participants, 192 (7%) had subarachnoid extension, which was associated with larger hematoma volumes (P<0.0001) and higher National Institute of Health Stroke Scale score (P<0.0001). Subarachnoid extension predicted death or major disability at 90 days (71% versus 53%; unadjusted odds ratio, 2.25; 95% confidence interval, 1.63-3.10; P<0.0001). The association remained significant after adjusting for age, region, lipid-lowering therapy, systolic blood pressure, glucose, location of hematoma, intraventricular extension, and randomized treatment (odds ratio, 2.17; 95% confidence interval, 1.50-3.14; P<0.0001), but not after further adjustment for baseline hematoma volume (P=0.62). CONCLUSIONS: Subarachnoid extension of intracerebral hemorrhage is associated with poor prognosis, which is determined by a larger volume of the underlying intraparenchymal hematoma. CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
PY - 2013 SN - 1524-4628 (Electronic) - 0039-2499 (Linking) ST - T2 - Stroke TI - Subarachnoid Extension of Intracerebral Hemorrhage and 90-Day Outcomes in INTERACT2 ER -