Pre-hospital transdermal glyceryl trinitrate for transient ischaemic attack: Data from the RIGHT-2 trial

Appleton, Jason P., Dixon, Mark, Woodhouse, Lisa J., Anderson, Craig S., Ankolekar, Sandeep, Cala, Lesley, England, Timothy J., Godolphin, Peter J., Krishnan, Kailash, Mair, Grant, Muir, Keith W., Potter, John, Price, Chris I., Randall, Marc, Robinson, Thompson G., Roffe, Christine, Rothwell, Peter M., Sandset, Else Charlotte, Saver, Jeffrey L., Siriwardena, A. Niroshan, Wardlaw, Joanna M., Sprigg, Nikola and Bath, Philip M. and RIGHT-2 Investigators (2024) Pre-hospital transdermal glyceryl trinitrate for transient ischaemic attack: Data from the RIGHT-2 trial. European Journal of Neurology, 31 (12). ISSN 1351-5101

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Abstract

Background and purpose: Ambulance trials assessing interventions in suspected stroke patients will recruit patients with currently active symptoms that will resolve into transient ischaemic attack (TIA). The safety and efficacy of glyceryl trinitrate (GTN) in the pre-specified subgroup of patients with TIA in the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke Trial 2 (RIGHT-2) was assessed.   Methods: RIGHT-2 was a pre-hospital-initiated multicentre randomized sham-controlled blinded-endpoint trial that randomized patients with presumed ultra-acute stroke within 4 h of symptom onset to transdermal GTN or sham. Final diagnosis was determined by site investigators. The primary outcome was a shift in modified Rankin Scale (mRS) scores at 90 days analysed using ordinal logistic regression reported as adjusted common odds ratio with 95% confidence intervals (CIs). Secondary outcomes included death or dependence (mRS >2).   Results: In all, 109 of 1149 (9.5%) patients had a final diagnosis of TIA (GTN 57, sham 52) with mean age 73 (SD 13) years, 19 (17.4%) had pre-morbid mRS >2, and onset to randomization was 80 min (interquartile range 49, 105). GTN lowered blood pressure by 7.4/5.2 mmHg compared with sham by hospital arrival. At day 90, GTN had no effect on shift in mRS scores (common odds ratio for increased dependence 1.47, 95% CI 0.70–3.11) but was associated with increased death or dependence (mRS >2): GTN 29 (51.8%) versus sham 23 (46.9%), odds ratio 3.86 (95% CI 1.09–13.59).   Conclusions: Pre-hospital ultra-acute transdermal GTN did not improve overall functional outcome in patients with investigator-diagnosed TIA compared with sham treatment.

Item Type:	Article
Additional Information:	Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Funding information: UK Dementia Research Institute; British Heart Foundation. Grant Number: CS/14/4/30972; Nottingham University Hospitals NHS Trust; Stroke Association. Grant Number: SA L-SMP 18/1000.
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Depositing User:	LivePure Connector
Date Deposited:	24 Sep 2024 12:56
Last Modified:	12 Nov 2024 15:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/96802
DOI:	10.1111/ene.16502

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