Long-Term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolytic Therapy

• Published in: Journal of stroke and cerebrovascular diseases 2017-01, Vol.26 (1), p.196-203
• Main Authors: Stefanovic Budimkic, Maja, MD, Pekmezovic, Tatjana, MD, PhD, Beslac-Bumbasirevic, Ljiljana, MD, PhD, Ercegovac, Marko, MD, PhD, Berisavac, Ivana, MD, Stanarcevic, Predrag, MD, Padjen, Visnja, MD, PhD, Jovanović, Dejana R., MD, PhD
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Age Factors; Aged; Brain Ischemia - diagnosis; Brain Ischemia - drug therapy; Cardiovascular; Diabetes Complications; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Humans; intravenous thrombolysis; Long-term prognosis; Male; Middle Aged; Neurology; predictors of outcome after stroke; Prognosis; Recombinant Proteins - therapeutic use; Recovery of Function; Severity of Illness Index; stroke; Stroke - diagnosis; Stroke - drug therapy; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.009

Background and Purpose It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke. Methods This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013. Results After a median follow-up period of 3 years (range, 1-7 years), survival did not differ significantly between the groups; specifically, 56 patients (21.6%) in the thrombolysed group died versus 62 patients (23.94%) in the nonthrombolysed group (log-rank, .240, P  = .624). Based on a multivariate Cox proportional hazards regression model, older age (>70 years), stroke severity (National Institutes of Health Stroke Scale score ≥ 15), diabetes mellitus, and a history of atrial fibrillation were independent predictors of long-term mortality after stroke. After the follow-up period, 144 patients (55.6%) in the IVT-treated group versus 112 patients (43.2%) in the control group had an excellent outcome, with a modified Rankin Scale score of 0-1 (hazard ratio [HR] = 1.64, 95% confidence interval [CI] = 1.16-2.32). Based on a multivariate Cox proportional hazards regression model, an excellent 3-month functional recovery was a strong predictor of favorable outcome (HR = 11.27, 95% CI = 6.45-19.63). Conclusion The results suggest that IVT for acute IS has a favorable effect on functional recovery more than 1 year after stroke.