Predictors of long-term outcome after intravenous or intra-Arterial recombinant tissue plasminogen activator treatment in the eastern Hungarian thrombolysis database

Klára Fekete, Sándor Márton, Judit Tóth, L. Csiba, I. Fekete, D. Bereczki

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Abstract

Background This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population. Methods Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing. Results Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55%. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8%. Outcome was significantly worse, and SICH was more frequent in intra-Arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤2), and 23% were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year. Conclusions Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.

Original languageEnglish
Pages (from-to)117-124
Number of pages8
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number1
DOIs
Publication statusPublished - Jan 1 2015

Fingerprint

Tissue Plasminogen Activator
Stroke
Databases
National Institutes of Health (U.S.)
Alberta
Therapeutics
Cerebral Hemorrhage
Tomography
Neurology
Delivery of Health Care
Glucose

Keywords

  • Ischemic stroke
  • outcome
  • predictors
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

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title = "Predictors of long-term outcome after intravenous or intra-Arterial recombinant tissue plasminogen activator treatment in the eastern Hungarian thrombolysis database",
abstract = "Background This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population. Methods Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing. Results Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55{\%}. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8{\%}. Outcome was significantly worse, and SICH was more frequent in intra-Arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤2), and 23{\%} were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year. Conclusions Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.",
keywords = "Ischemic stroke, outcome, predictors, thrombolysis",
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T1 - Predictors of long-term outcome after intravenous or intra-Arterial recombinant tissue plasminogen activator treatment in the eastern Hungarian thrombolysis database

AU - Fekete, Klára

AU - Márton, Sándor

AU - Tóth, Judit

AU - Csiba, L.

AU - Fekete, I.

AU - Bereczki, D.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population. Methods Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing. Results Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55%. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8%. Outcome was significantly worse, and SICH was more frequent in intra-Arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤2), and 23% were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year. Conclusions Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.

AB - Background This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population. Methods Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing. Results Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55%. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8%. Outcome was significantly worse, and SICH was more frequent in intra-Arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤2), and 23% were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year. Conclusions Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.

KW - Ischemic stroke

KW - outcome

KW - predictors

KW - thrombolysis

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