Relación entre discapacidad y las metas de presión arterial en pacientes adultos cursando con ataque cerebro vascular isquémico llevados a terapia de reperfusión: una revisión sistemática de la literatura

Abstract

Background: Drops in Systolic arterial pressure (SAP) below the 140 mmHg after Stroke occurs between 18% and 25% and can be associated with adverse outcomes, disability and increase mortality, because the arterial pressure augmentation in ischemic stroke could be beneficial due to recover penumbra perfusion in the peri-infarct zone. Nevertheless, stroke patients have comorbid conditions and could have further neurological deterioration because the drop in de cerebral perfusion pressure or by the hemorrhagic transformation on the reperfusion therapy. Methods: We performed a systematic review in Medline, Embasse, Cochrane library, Lilacs and Opengrey databases for clinical studies that research the relationship among the arterial pressure after reperfusion therapy in ischemic stroke and outcomes in disability and mortality. Two independent investigators review all tittles and later the abstracts that a priori fulfill the inclusion criteria. Finally, they review and read the complete papers to include the relevant articles in respect to the clinical question and the data extraction. Results: The papers related with ischemic stroke were 2,200 and found 71 articles about arterial pressure goals after the reperfusion therapy of which 7 studies met the criteria for our study. The research included 7571 patients (aged: 68.7 years, 55.1% male). The most reported comorbidities were arterial hypertension in 67.7%, auricular fibrillation 28.2%, diabetes mellitus 26.3%, previous stroke 10.2%, coronary artery disease 8.7%, chronic heart failure 3.2%, smokers 16%. The average NIHSS was 14.3 and ASPECTS scale 85. The most commonly used reperfusion therapy was de intravenous thrombolysis in 71% of cases. The average of successful reperfusion therapy was 46.9%. But the patients heterogenicity and the way to report the outcomes the metanalysis was not possible in this systematic review. The patients managed with systolic arterial pressure between 130 – 140 mmHg had better neurological outcomes compared with SAP above 140 mmHg (OR: 2.37, CI: 0.95 – 1.20, p-value<0.001) as well less probability of intracerebral hemorrhage (OR: 0.83, CI: 0.73 – 0.95, p-value<0.001) and mortality (OR: 0.73, CI: 0.62 – 0.95 p-value=0.01). The benefit and risks to recommended arterial pressure ranges remains unknown, but the intensive monitoring is recommended. Conclusion: The current study found that the relationship between arterial pressure levels above 140 mmHg after reperfusion therapy in ischemic stroke and the probability to have worse outcomes among 30 days to 6 months. We also found as an additional finding that probably the PAS above 130 mmHg could be in relationship to have a worse outcome.