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Abstract
Objective To prospectively investigate the relationships between serum tissue inhibitor metalloproteinase-1 (TIMP-1) and clinical outcomes in patients with acute ischemic stroke.
Methods We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke. Baseline serum TIMP-1 concentrations were measured in 3,342 participants. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events.
Results A total of 843 participants (25.2%) experienced major disability or died within 3 months. After adjustment for age, sex, admission NIH Stroke Scale score, and other important covariates, odds ratios or hazard ratios (95% confidence intervals) of 1-SD (0.17 ng/mL) higher log-TIMP-1 were 1.17 (1.06–1.29) for the primary outcome, 1.13 (1.02–1.25) for major disability, 1.49 (1.19–1.87) for death, and 1.34 (1.11–1.62) for the composite outcome of death and vascular events. The addition of serum TIMP-1 to conventional risk factors model significantly improved risk prediction of the primary outcome (net reclassification index 9.0%, p = 0.02; integrated discrimination improvement 0.2%, p = 0.03). Participants with both higher TIMP-1 and matrix metalloproteinase-9 levels simultaneously had the highest risk of all study outcomes.
Conclusions Higher TIMP-1 levels were associated with increased risk of mortality and major disability after acute ischemic stroke. Our findings provided evidence supporting the important prognostic role of extracellular matrix biomarkers after acute ischemic stroke.
Glossary
- BP=
- blood pressure;
- CATIS=
- China Antihypertensive Trial in Acute Ischemic Stroke;
- CI=
- confidence interval;
- ECM=
- extracellular matrix;
- eGFR=
- estimated glomerular filtration rate;
- GFR=
- glomerular filtration rate;
- HR=
- hazard ratio;
- IDI=
- integrated discrimination improvement;
- MMP=
- matrix metalloproteinase;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- NRI=
- net reclassification index;
- OR=
- odds ratio;
- SMC=
- smooth muscle cell;
- TIMP=
- tissue inhibitor metalloproteinase-1
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received January 7, 2019.
- Accepted in final form May 23, 2019.
- © 2019 American Academy of Neurology
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