Impact of ultra/hyper-acute administration of glyceryl trinitrate on secondary outcome after acute stroke: a meta-analysis of individual patient data from randomised trials

Bath, Philip M.; Woodhouse, Lisa J.; Sprigg, Nikola

Abstract

Background Glyceryl trinitrate (GTN) is a candidate reperfusion and hypotensive treatment for hyperacute stroke. We assessed the effect of early administration of GTN (within 6 hours) on secondary outcomes (taken at 3 months post randomisation), across two studies, ENOS-early and RIGHT, in an individual patient data meta-regression.
Methods: Secondary outcomes included disability (Barthel index, BI), quality of life (EQ-5D health status utility values, HSUV, and Visual Analogue Scale, EQ-VAS), cognition (telephoneMini Mental state examination, t-MMSE, and the Telephone Interview Cognition Scalemodified, TICS-M) and mood (Zung Depression Scale, ZDS). Outcomes were analysed using multiple linear regression (MLR) and Mann-Whitney U test (MWU). Data are mean (standard deviation), median [interquartile range] and mean difference (MD) with 95% confidence intervals (CI).
Results: 312 patients (GTN 168, no GTN 144) were randomised within 6 hours of ictus into ENOS-early (n=273) and RIGHT (39). Results from the analyses undertaken can be found in Table 1. Patients who received GTN appeared to see more improvement, across all their outcomes, than patients who did not receive GTN. This result was seen whether analysed using parametric (MLR) or non-parametric methods (MWU).
Conclusions: GTN, when given within 6 hours of ictus, appears to improve functional outcomes relating to disability, quality of life, cognition and mood. This exploratory finding is being tested prospectively in the ongoing RIGHT-2 trial.

Citation

Bath, P. M., Woodhouse, L. J., & Sprigg, N. (2018). Impact of ultra/hyper-acute administration of glyceryl trinitrate on secondary outcome after acute stroke: a meta-analysis of individual patient data from randomised trials

• Conference Name: 11th World Stroke Congress 2018
• Start Date: Oct 17, 2018
• End Date: Oct 20, 2018
• Acceptance Date: May 27, 2018
• Publication Date: Oct 17, 2018
• Deposit Date: Aug 17, 2018
• Publicly Available Date: Jan 18, 2019
• Public URL: https://nottingham-repository.worktribe.com/output/1037107
• Additional Information: Abstract 529 published in International Journal of Stroke, v. 13, issue 2 supplement, October 2018.