title: Predicting clinical outcomes after thrombolysis using the iScore: results from the Virtual International Stroke Trials Archive.
abstract: OBJECTIVE
  The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA).
  
  
  METHODS
  We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4-6), and Barthel index >90 at 3 months.
  
  
  RESULTS
  Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30-1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45-1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death.
  
  
  CONCLUSIONS
  The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
authors.affiliation: From the Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, Institute of Health Policy, Management and Evaluation (iHPME), University of Toronto, Toronto, Canada (G.S.); Departments of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI (M.J.R.); Clinical and Translational Science Institute, Department of Neurology, University of California, San Francisco, CA (S.C.J.); Stroke Trials Unit, Division of Stroke Medicine, University of Nottingham, Nottingham, United Kingdom (P.M.W.B.); Department of Neurology, Medical University of South Carolina, Charleston, SC (B.O.); and Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada (G.S.).
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: iScore; outcomes; predicting score; prognosis