Prehospital transdermal glyceryl trinitrate for ultra- acute ischaemic stroke: data from the RIGHT- 2 randomised sham- controlled ambulance trial  

作　　者：Jason Philip Appleton Lisa J Woodhouse Craig S Anderson Sandeep Ankolekar Lesley Cala Mark Dixon Timothy J England Kailash Krishnan Grant Mair Keith W Muir John Potter Christopher I Price Marc Randall Thompson G Robinson Christine Roffe Else C Sandset Jeffrey L Saver Angela Shone Aloysius Niroshan Siriwardena Joanna M Wardlaw Nikola Sprigg Philip M Bath 

机构地区：[1]Stroke,University Hospitals Birmingham NHS Foundation Trust,Birmingham,UK [2]Institute of Applied HealthResearch,University of Birmingham College of Medical and Dental Sciences,Birmingham,UK [3]Stroke Trials Unit,Mental Health and Clinical Neurosciences,University of Nottingham,Nottingham,UK [4]Faculty of Medicine,The George Institute for Global Health,Sydney,New South Wales,Australia [5]The George Institute China at Peking University Health Science Center,Beijing,China [6]Neurology,Royal Prince Alfred Hospital,Sydney Health Partners,Sydney,New South Wales,Australia [7]Department of Neurology,King's College Hospital NHS Foundation Trust,London,UK [8]Faculty of Health and Medical Sciences,University of Western Australia,Crawley,Western Australia,Australia [9]East Midlands Ambulance Service NHS Trust,Nottingham,UK [10]Stroke,Queen's Medical Centre,Nottingham University Hospitals NHS Trust,Nottingham,UK [11]Centre for Clinical Brain Sciences,Dementia Research Institute,Univeristy of Edinburgh,Edinburgh,UK [12]Institute of Neurology and Psychology,University of Glasgow,Glasgow,UK [13]Bob Champion Research and Education Building,University of East Anglia,Norwich,UK [14]Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK [15]Department of Neurology,Leeds Teaching Hospitals NHS Trust,Leeds,UK [16]Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre,University of Leicester,Leicester,UK [17]Stroke Research in Stoke,Institute for Science and Technology in Medicine,Keele University,Stoke-on Trent,UK [18]Department of Neurology,Oslo University Hospital,Oslo,Norway [19]Research and Development,Norwegian Air Ambulance Foundation,Oslo,Norway [20]Department of Neurology and Comprehensive Stroke Center,David Geffen School of Medicine,UCLA,Los Angeles,California,USA [21]Research and Graduate Services,University of Nottingham,Nottingham,UK [22]Community and Health Research Unit,University of Lincoln,Lincoln,UK

出　　处：《Stroke & Vascular Neurology》2024年第1期38-49,I0035-I0046,共24页卒中与血管神经病学（英文）

基　　金：British Heart Foundation(grant number CS/14/4/30972);JPA is supported by an NIHR Health and Care Research Scholarship.PMB is Stroke Association Professor of Stroke Medicine and an NIHR Senior Investigator.TR is an NIHR Senior Investigator.GM is the Stroke Association Edith Murphy Foundation Senior Clinical Lecturer(SA L-SMP 18\1000).

摘　　要：Background The effect of transdermal glyceryl trinitrate(GTN,a nitrovasodilator)on clinical outcome when administered before hospital admission in suspected stroke patients is unclear.Here,we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2(RIGHT-2).Methods RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4hours of onset.The primary outcome was a shift in scores on the modified Rankin scale(mRS)at day 90.Secondary outcomes included death;a global analysis(Wei-Lachin test)containing Barthel Index,EuroQol-5D,mRS,telephone interview for cognitive status-modified and Zung depression scale;and neuroimaging-determined‘brain frailty’markers.Data were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%CI.Results 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS>2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]min.Neuroimaging‘brain frailty’was common:median score 2[2,3](range 0–3).At day 90,GTN did not influence the primary outcome(acOR for increased disability 1.15,95%CI 0.85 to 1.54),death or global analysis(MWD 0.00,95%CI-0.10 to 0.09).In subgroup analyses,there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1hour of symptom onset and in those with more severe stroke.Conclusions In patients who had an ischaemic stroke,ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital trials.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those with acute stroke treated within 6hou

关 键 词：GLASGOW nitrate random 

分 类 号：R743.3[医药卫生—神经病学与精神病学]