Identification of Prognostic Factors for Thrombolytic Therapy in Patients with Acute Stroke – Analysis of the SITS Registry
Authors:
M. Bar 1; P. Kadlecová 2; D. Václavík 3; J. Neumann 4; O. Škoda 5; R. Mikulík 6
Authors‘ workplace:
Neurologická klinika LF OU a Fakultní nemocnice Ostrava
1; Mezinárodní centrum klinického výzkumu (ICRC), FN u sv. Anny v Brně
2; Neurologické oddělení, Iktové centrum Vítkovické nemocnice a. s., Ostrava
3; Neurologické oddělení, Krajská zdravotní, a. s. – Nemocnice Chomutov, o. z.
4; Neurologické oddělení, Nemocnice Jihlava a Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha
5; Mezinárodní centrum klinického výzkumu (ICRC), Neurologická klinika LF MU a FN u sv. Anny v Brně
6
Published in:
Cesk Slov Neurol N 2012; 75/108(4): 426-431
Category:
Original Paper
Overview
Determination of predictors of a favourable outcome in patients treated with thrombolytic therapy for acute stroke, analysis of the SITS (Safe Implementation of Treatments in Stroke) Registry.
Background:
Identification of predictors of a favourable outcome in stroke patients treated with thrombolysis might help in determining their prognosis and individualizing treatment. The aim of our study was to identify predictors of a favourable outcome in stroke patients treated with systemic thrombolysis.
Method:
We analyzed data entered in the SITS Registry (Safe Implementation of Treatments in Stroke) in the Czech Republic between February 2003 and February 2010. Univariate and multivariate regressive analyses were used to identify predictors of a favourable outcome as defined by the modified Rankin scale 0–1 at 3 months.
Results:
Overall in the Czech Republic, 3,053 patients were treated with intravenous thrombolysis. A total of 462 (15%) patients died and 1,308 (43%) achieved a favourable outcome. Symptomatic intracerebral haemorrhages (as per the SITS definition) were observed in 62 (2%) patients. Multivariate analyses identified the following characteristics to be significantly associated with a favourable outcome: age (10-year increments) – OR 0.90, 95% CI (0.83–0.97); systolic blood pressure (10 mmHg increments) – OR 0.92, 95% CI (0.88–0.97); stroke severity at baseline measured by NIHSS score (5-point increments) – OR 0.52, 95% CI (0.47–0.56); glucose (5 mmol/L increments) – OR 0.61, 95% CI (0.51–0.73) and diagnosis of embolic etiology of stroke (I63.4 according to the International Classification of Diseases) – OR 0.75, 95% CI (0.62–0.90).
Conclusion:
In our study, we identified several important prognostic predictors determining a clinical outcome of stroke patients treated with intravenous thrombolysis in the Czech Republic. Knowledge of these predictors allows clinicians to predict patient prognosis and manage risk factors.
Key words:
ischemic stroke – intravenous thrombolysis – predictors – outcome
Sources
1. Goldemund D, Mikulik R. Reperfusion therapies for acute ischemic stroke. Curr Treat Options Neurol 2010; 12(2): 155–166.
2. Bar M, Sandercock P, Skoloudik D, Prochazka V. Should mechanical embolectomy devices be used in routine clinical practice? J Neural Transm 2011; 118(8): 1131–1138.
3. Wahlgren N, Ahmed N, Dávalos A, Hacke W, Millán M, Muir K et al. Thrombolysis with alteplase 3–4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet 2008; 372(9646):
1303–1309.
4. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317–1329.
5. Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M et al. Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: retrospective analysis from Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Stroke 2009; 40(7): 2442–2449.
6. Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST). Stroke 2008; 39(12): 3316–3322.
7. Kharitonova T, Mikulik R, Roine RO, Soinne L, Ahmed N, Wahlgren N et al. Association of early National Institutes of Health Stroke Scale improvement with vessel recanalization and functional outcome after intravenous thrombolysis in ischemic stroke. Stroke 2011; 42(6): 1638–1643.
8. Mishra NK, Ahmed N, Andersen G, Egido JA, Lindsberg PJ, Ringleb PA et al. Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive. BMJ 2010; 341: c6046.
9. Sanak D, Herzig R, Zapletalova J, Horak D, Kral M, Skoloudik D et al. Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis. Acta Neurol Scand 2011; 123(5): 339–344.
10. Sanak D, Herzig R, Hubacek R, Kral M, Veverka T, Zapletalova J et al. Rozšíření terapeutického časového okna pro intravenózní trombolýzu by nemělo vést k prodloužení „door-to-needle time“ intervalu. Cesk Slov Neurol N 2011; 74/107(6): 685–688.
11. Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369(9558): 275–282.
12. Kobayashi A, Czlonkowska A, Ahmed N, Romanowicz S, Glonek M, Nyka WM et al. Intravenous recombinant tissue plasminogen activator for acute stroke in Poland: an analysis based on the Safe Implementation of Thrombolysis in Stroke (SITS) Registry. Acta Neurol Scand 2010; 122(4): 229–236.
13. Topakian R, Brainin M, Eckhardt R, Kiechl S, Ahmed N, Ferrari J et al. Thrombolytic therapy for acute stroke in Austria: data from the Safe Implementation of Thrombolysis in Stroke (SITS) register. Eur J Neurol 2011; 18(2): 306–311.
14. Lees KR, Ford GA, Muir KW, Ahmed N, Dyker AG, Atula S et al. Thrombolytic therapy for acute stroke in the United Kingdom: experience from the safe implementation of thrombolysis in stroke (SITS) register. QJM 2008; 101(11): 863–869.
15. Vanacker P, Thijs V, Peeters A, Bruneel B, Laloux P, Druwé P et al. The Belgian experience with intravenous thrombolysis for acute ischemic stroke. Acta Neurol Belg 2010; 110(2): 157–162.
16. Alvarez-Sabín J, Molina CA, Rubiera M, Montaner J, Arenillas JF, Santamarina E et al. Impact of admission hyperglycemia on stroke outcome after thrombolysis: risk stratification in relation to time to reperfusion. Stroke 2004; 35(11): 2493–2498.
17. Ribo M, Molina CA, Delgado P, Rubiera M, Delgado-Mederos R, Rovira A et al. Hyperglycemia during ischemia rapidly accelerates brain damage in stroke patients treated with tPA. J Cereb Blood Flow Metab 2007; 27(9): 1616–1622.
18. Li PA, Shuaib A, Miyashita H, He QP, Siesjo BK, Warner DS. Hyperglycemia enhances extracellular glutamate accumulation in rats subjected to forebrain ischemia. Stroke 2000; 31(1): 183–192.
19. Fukuoka S, Yeh H, Mandybur TI, Tew JM Jr. Effect of insulin on acute experimental cerebral ischemia in gerbils. Stroke 1989; 20(3): 396–399.
20. Ribo M, Molina C, Montaner J, Rubiera M, Delgado-Mederos R, Arenillas JF et al. Acute hyperglycemia state is associated with lower tPA-induced recanalization rates in stroke patients. Stroke 2005; 36(8): 1705–1709.
21. Garg R, Chaudhuri A, Munschauer F, Dandona P. Hyperglycemia, insulin, and acute ischemic stroke: a mechanistic justification for a trial of insulin infusion therapy. Stroke 2006; 371: 267–273.
22. Executive Committee and the European Stroke Organization Writing Committee: ESO Guidelines for Management of Ischaemic Stroke Update 2009: 55–56 [online]. Dostupné z URL: www.eso-stroke.org.
23. Ahmed N, Dávalos A, Eriksson N, Ford GA, Glahn J, Hennerici M et al. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis: results from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register (SITS-ISTR). Arch Neurol 2010; 67(9): 1123–1130.
24. Engelter ST, Bonati LH, Lyrer PA. Intravenous thrombolysis in stroke patients of > or = 80 versus < 80 years of age – a systematic review across cohort studies. Age Ageing 2006; 35(6): 572–580.
25. Petrovicsová M, Kadlecová P, Václavík D, Šaňák D, Ševčík P, Mikulík R et al. Bezpečnost a účinnost intravenózní trombolytické terapie mozkového infarktu u pacientů nad 80 let. Cesk Slov Neurol N 2011; 74/ 107 (Suppl): S27.
26. Sandset EC, Bath PM, Boysen G, Jatuzis D, Kõrv J, Lüders S et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet 2011; 377(9767): 741–750.
27. Executive Committee and the European Stroke Organization Writing Committee: ESO Guidelines for Management of Ischaemic Stroke Update 2009: 51–52 [online]. Dostupné z URL: www.eso-stroke.org.
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
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