Vascular Risk Factors in Patients with Different Subtypes of Ischemic Stroke May Affect Their Outcome after Intravenous tPA

<div><p>Intravenous (IV) tissue-type plasminogen activator (tPA) is the only approved noninvasive therapy for acute ischemic stroke (AIS). However, after tPA treatment, the outcome of patients with different subtypes of stroke according to their vascular risk factors remains to be elucidated. We aim to explore the relationship between the outcome and different risk factors in patients with different subtype of acute strokes treated with IV tPA. Records of patients in this cohort were reviewed. Data collected and analysed included the demographics, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) scores, 90-day modified Rankin Scores (mRS), and subtypes of stroke. By using the 90-day mRS, patients were dichotomized into favorable versus unfavorable outcome in each subtype of stroke. We identified the vascular risk factors that are likely associated with the poor outcome in each subtype. Among 570 AIS patients received IV tPA, 217 were in the large artery atherosclerosis (LAA) group, 146 in the small vessel occlusion(SVO) group, and 140 in the cardioaortic embolism(CE) group. Lower NIHSS score on admission was related to favorable outcome in patients in all subtypes. Patients with history of dyslipidemia were likely on statin treatment before their admission and hence less likely to have elevated cholesterol level on admission. Therefore, there was a possible paradoxical effect on the outcome in patients with LAA and SVO subtypes of strokes. SVO patients with history of diabetes had higher risk of unfavorable outcome. SVO patients had favorable outcome if their time from onset to treatment was short. In conclusion, the outcome of patients treated with IV tPA may be related to different vascular risk factors associated with different subtypes of stroke.</p></div

Risk factors of outcomes in different subtype of stroke patients in multivariable logistic regression.

<p>Risk factors of outcomes in different subtype of stroke patients in multivariable logistic regression.</p

Characteristics of acute stroke patients with intravenous tPA at baseline.

<p>Characteristics of acute stroke patients with intravenous tPA at baseline.</p

The Comparison on door to needle intervals more of > 60 minutes in logistic regression model analysis.

<p>According to the door to needle (DTN) intervals of > 60 minutes or not, the patients were divided into two groups and related factors were assessed. Since DTN is a more accurate measure and the onset to treatment (OTT) intervals along with the ethnicity of patients were quite different from these two hospitals, we removed race and OTT from this analysis. OR = odds ratio; CI = confidential interval; NIHSS = National Institute of Health Stroke Scale; sICH = symptomatic intracranial hemorrhage; mRS = modified Rankin Scale were divided into two groups, favorable outcome as mRS scores 0 or 1, unfavorable outcome as mRS scores 2 or more; HS = Huashan Hospital; CBC = the complete blood counts result back before tPA.</p><p>The Comparison on door to needle intervals more of > 60 minutes in logistic regression model analysis.</p

Demographic and clinical characteristics of AIS patients treated with IV tPA.

<p>SD = standard deviation; NIHSS = National Institute of Health Stroke Scale; mRS = modified Rankin Scale; sICH = symptomatic intracranial hemorrhage; INI = Illinois Neurological institute/OSF Comprehensive stroke center; HS = Huashan Hospital; CBC = complete blood counts</p><p>Demographic and clinical characteristics of AIS patients treated with IV tPA.</p

Different DTN distributions between with/without CBC before tPA.

<p>DTN = door to needle intervals, CBC = complete blood count, tPA = tissue plasminogen activator; INI = Illinois Neurological Institute/OSF Comprehensive stroke center.</p