title: Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke.
abstract: OBJECTIVE
  Mild or rapidly improving stroke is a frequently cited reason for not giving intravenous recombinant tissue-type plasminogen activator (rtPA), but some of these patients may have poor outcomes. We used data from a large nationwide study (Get With The Guidelines-Stroke) to determine risk factors for poor outcomes after mild or improving stroke at hospital discharge.
  
  
  METHODS
  Between 2003 and 2009, there were 29,200 ischemic stroke patients (from 1092 hospitals) arriving within 2 hours after symptom onset with mild or rapidly improving stroke symptoms as the only contraindication to rtPA. Logistic regression was used to determine the independent predictors of discharge to home.
  
  
  RESULTS
  Among 93,517 patients arriving within 2 hours, 31.2% (29,200) did not receive rtPA solely because of mild/improving stroke. Among the 29,200 mild/improving cases, 28.3% were not discharged to home, and 28.5% were unable to ambulate without assistance at hospital discharge. The likelihood of home discharge was strongly related to initial National Institutes of Health Stroke Scale score (P<0.001). In multivariable-adjusted analysis, patients not discharged to home were more likely to be older, female, and black; have a higher National Institutes of Health Stroke Scale score and vascular risk factors; and were less likely to be taking lipid-lowering medication before admission.
  
  
  CONCLUSIONS
  In this large, nationwide study, a sizeable minority of patients who did not receive intravenous rtPA solely because of mild/improving stroke had poor short-term outcomes, raising the possibility that stroke-related disability is relatively common, even in "mild" stroke. A controlled trial of reperfusion therapy in this population may be warranted.
authors: Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada. eesmith@ucalgary.ca
authors: Eric E
authors: EE
authors: Smith
authors: Gregg C
authors: GC
authors: Fonarow
authors: Mathew J
authors: MJ
authors: Reeves
authors: Margueritte
authors: M
authors: Cox
authors: Daiwai M
authors: DM
authors: Olson
authors: Adrian F
authors: AF
authors: Hernandez
authors: Lee H
authors: LH
authors: Schwamm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012042:Registries / Q000592:standards; D012075:Remission, Spontaneous; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator