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Cerebrovascular disease
Research paper
Higher mortality in patients with right hemispheric intracerebral haemorrhage: INTERACT1 and 2
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  1. Shoichiro Sato1,
  2. Emma Heeley1,
  3. Hisatomi Arima1,
  4. Candice Delcourt1,
  5. Yoichiro Hirakawa1,
  6. Vijaya Pamidimukkala2,
  7. Zhendong Li3,
  8. Qingling Tao4,
  9. Yuehong Xu5,
  10. Michael G Hennerici6,
  11. Thompson Robinson7,
  12. Christophe Tzourio8,
  13. Richard I Lindley1,
  14. John Chalmers1,
  15. Craig S Anderson1
  16. for the INTERACT Investigators
  1. 1The George Institute for Global Health, the University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  2. 2Lalitha Super Specialities Hospital, Guntur, Andhra Pradesh, India
  3. 3Department of Neurology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Guangdong, China
  4. 4Department of Neurology, Chang Ning District Central Hospital, Shanghai, China
  5. 5Department of Neurology, Shijiazhuang 260 Hospital, Hebei, China
  6. 6Department of Neurology, University of Heidelberg UMM Mannheim, Mannheim, Germany
  7. 7Department of Cardiovascular Sciences, and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK
  8. 8INSERM U897, University of Bordeaux, Bordeaux, France
  1. Correspondence to Professor Craig Anderson, The George Institute for Global Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia, canderson{at}georgeinstitute.org.au

Abstract

Background and purpose Controversy exists over the prognostic significance of the affected hemisphere in stroke. We aimed to determine the relationship between laterality of acute intracerebral haemorrhage (ICH) and poor clinical outcomes.

Methods A subsidiary analysis of the INTERACT Pilot and INTERACT2 studies—randomised controlled trials of patients with spontaneous acute ICH with elevated systolic blood pressure (BP), randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Outcomes were the combined and separate end points of death and major disability (modified Rankin scale (mRS) scores of 3–6, 6 and 3–5, respectively) at 90 days.

Results A total of 2708 patients had supratentorial/hemispheric ICH and information on mRS at 90 days. Patients with right hemispheric ICH (1327, 49%) had a higher risk of death at 90 days compared to those with left hemispheric ICH after adjustment for potential confounding variables (OR, 1.77 (95% CI 1.33 to 2.37)). There were no differences between patients with right and left hemispheric ICH regarding the combined end point of death or major disability or major disability in the multivariable-adjusted models (1.07 (0.89 to 1.29) and 0.85 (0.72 to 1.01), respectively).

Conclusions Right hemispheric lesion was associated with increased risk of death in patients with acute ICH. The laterality of the ICH does not appear to affect the level of disability in survivors.

Trial registration number URL: http://www.clinicaltrials.gov. Unique identifier: NCT00226096 and NCT00716079.

  • CEREBROVASCULAR DISEASE

https://doi.org/10.1136/jnnp-2014-309870

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