title: Predictors of in-hospital death and symptomatic intracranial hemorrhage in patients with acute ischemic stroke treated with thrombolytic therapy: Paul Coverdell Acute Stroke Registry 2008-2012.
abstract: BACKGROUND
  Limited studies exist on the outcome of thrombolytic therapy of acute ischemic stroke patients outside of clinical trials.
  
  
  OBJECTIVE
  To assess the possible risk factors associated with in-hospital death and symptomatic intracerebral hemorrhage among patients who received intravenous tissue plasminogen activator.
  
  
  METHODS
  A total of 7193 patients with a clinical diagnosis of acute ischemic stroke and a documented National Institutes of Health Stroke Scale score were treated with intravenous tissue plasminogen activator within 4·5 hours of time last known to be well. Generalized estimating equations modeling was used to assess the associations of in-hospital death and symptomatic intracerebral hemorrhage with clinical characteristics.
  
  
  RESULTS
  Among 7193 patients treated with intravenous tissue plasminogen activator, 516 (7·2%) died during hospitalization. Factors associated with in-hospital death were older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of nonvalvular atrial fibrillation. Increasing age, higher National Institutes of Health Stroke Scale score, and history of dyslipidemia were associated with symptomatic intracerebral hemorrhage. There was no difference in the rates of in-hospital death or symptomatic intracerebral hemorrhage among patients treated with intravenous tissue plasminogen activator within three-hours of time last known to be well and those treated between three and 4·5 hours after this time.
  
  
  CONCLUSIONS
  In this study of acute ischemic stroke patients, older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of atrial fibrillation were associated with increased in-hospital death among patients receiving intravenous tissue plasminogen activator. Among patients treated with intravenous tissue plasminogen activator, in-hospital mortality and symptomatic intracerebral hemorrhage rates were similar between those treated within three-hours of time last known to be well and those treated between three and 4·5 hours after this time.
authors.affiliation: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Tong
authors.forename: Mary G
authors.initials: MG
authors.lastname: George
authors.forename: Quanhe
authors.initials: Q
authors.lastname: Yang
authors.forename: Cathleen
authors.initials: C
authors.lastname: Gillespie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute stroke; stroke outcomes; symptomatic intracerebral hemorrhage; thrombolysis
references.citation: Cerebrovasc Dis. 2011;31(3):223-8
references.pmid: 21178345
references.citation: JAMA. 2004 Oct 20;292(15):1831-8
references.pmid: 15494580
references.citation: Stroke Res Treat. 2012;2012:923676
references.pmid: 22848866
references.citation: J Emerg Med. 2011 Jan;40(1):82-92
references.pmid: 20576390
references.citation: Lancet. 2012 Jun 23;379(9834):2352-63
references.pmid: 22632908
references.citation: J Neurol Neurosurg Psychiatry. 2013 Mar;84(3):288-96
references.pmid: 23117498
references.citation: Cerebrovasc Dis. 2012;34(2):106-14
references.pmid: 22868870
references.citation: Circulation. 2011 Feb 22;123(7):739-49
references.pmid: 21300951
references.citation: Stroke. 2010 Dec;41(12):2840-8
references.pmid: 21030710
references.citation: Neurology. 2013 Jan 1;80(1):21-8
references.pmid: 23175723
references.citation: BMJ. 2010 Nov 23;341:c6046
references.pmid: 21098614
references.citation: Neurology. 2001 Aug 14;57(3):474-80
references.pmid: 11502916
references.citation: J Am Heart Assoc. 2012 Feb;1(1):42-50
references.pmid: 23130117
references.citation: Stroke. 2011 Jul;42(7):1952-5
references.pmid: 21636813
references.citation: Am J Emerg Med. 2010 Mar;28(3):359-63
references.pmid: 20223397
references.citation: Chest. 2012 Feb;141(2 Suppl):e601S-e636S
references.pmid: 22315273
references.citation: Stroke. 2012 Jan;43(1):240-2
references.pmid: 21998049
references.citation: Stroke. 2012 Nov;43(11):3108-9
references.pmid: 23042659
references.citation: Circulation. 2013 Jan 1;127(1):e6-e245
references.pmid: 23239837
references.citation: J Emerg Med. 2012 Dec;43(6):1149-54
references.pmid: 22818644
references.citation: Neurology. 2011 Nov 22;77(21):1866-72
references.pmid: 22094479
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Feb 25;60(7):206-10
references.pmid: 21346707
references.citation: MMWR Surveill Summ. 2009 Nov 6;58(7):1-23
references.pmid: 19893482
references.citation: Stroke. 2009 Jul;40(7):2438-41
references.pmid: 19478213
references.citation: Stroke. 2007 Aug;38(8):2275-8
references.pmid: 17569874
references.citation: Acta Neurol Scand. 2013 May;127(5):309-15
references.pmid: 22988960