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 

作者机构：StrokeUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK Institute of Applied HealthResearchUniversity of Birmingham College of Medical and Dental SciencesBirminghamUK Stroke Trials UnitMental Health and Clinical NeurosciencesUniversity of NottinghamNottinghamUK Faculty of MedicineThe George Institute for Global HealthSydneyNew South WalesAustralia The George Institute China at Peking University Health Science CenterBeijingChina NeurologyRoyal Prince Alfred HospitalSydney Health PartnersSydneyNew South WalesAustralia Department of NeurologyKing's College Hospital NHS Foundation TrustLondonUK Faculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern AustraliaAustralia East Midlands Ambulance Service NHS TrustNottinghamUK StrokeQueen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK Centre for Clinical Brain SciencesDementia Research InstituteUniveristy of EdinburghEdinburghUK Institute of Neurology and PsychologyUniversity of GlasgowGlasgowUK Bob Champion Research and Education BuildingUniversity of East AngliaNorwichUK Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK Department of NeurologyLeeds Teaching Hospitals NHS TrustLeedsUK Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK Stroke Research in StokeInstitute for Science and Technology in MedicineKeele UniversityStoke-on TrentUK Department of NeurologyOslo University HospitalOsloNorway Research and DevelopmentNorwegian Air Ambulance FoundationOsloNorway Department of Neurology and Comprehensive Stroke CenterDavid Geffen School of MedicineUCLALos AngelesCaliforniaUSA Research and Graduate ServicesUniversity of NottinghamNottinghamUK Community and Health Research UnitUniversity of LincolnLincolnUK 

出 版 物：《Stroke & Vascular Neurology》 (卒中与血管神经病学（英文）)

年 卷 期：2024年第9卷第1期

页      面：38-49,I0035-I0046页

核心收录：

学科分类：1002[医学-临床医学] 100204[医学-神经病学] 10[医学] 

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) 

主　　题：Glasgow nitrate random 

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 ***,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 *** primary outcome was a shift in scores on the modified Rankin scale(mRS)at day *** 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’*** were reported as n(%),mean(SD),median[IQR],adjusted common OR(acOR),mean difference or Mann-Whitney difference(MWD)with 95%*** 597 of 1149(52%)patients had a final diagnosis of ischaemic stroke;age 75(12)years,premorbid mRS2107(18%),Glasgow Coma Scale 14(2)and time from onset to randomisation 67[45,108]***‘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 *** 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 *** IS ALREADY KNOWN ON THIS TOPIC⇒Transdermal glyceryl trinitrate(GTN)was associat-ed with less death and dependency in those w