Role of preexisting disability in patients treated with intravenous thrombolysis for ischemic stroke.
OBJECTIVE
Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients' profile and outcome after intravenous thrombolysis.


METHODS
We analyzed the data of all stroke patients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke-Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression.


RESULTS
Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0-2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%).


CONCLUSIONS
Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.
From the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (M.K., A.K., A.C.); Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland (A.K.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center, Neurology Department, St Anne's Hospital in Brno, Brno, Czech Republic (R.M., D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.).
Michal
M
Karlinski
Adam
A
Kobayashi
Anna
A
Czlonkowska
Robert
R
Mikulik
Daniel
D
Vaclavik
Miroslav
M
Brozman
Viktor
V
Svigelj
Laszlo
L
Csiba
Klara
K
Fekete
Janika
J
Kõrv
Vida
V
Demarin
Aleksandras
A
Vilionskis
Dalius
D
Jatuzis
Yakup
Y
Krespi
Niaz
N
Ahmed
Nils
N
Wahlgren
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D015897:Comorbidity; D016001:Confidence Intervals; D004185:Disability Evaluation; D006233:Persons with Disabilities; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D064266:Preexisting Condition Coverage; D011379:Prognosis; D012042:Registries; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
comorbidity; stroke; thrombolytic therapy; treatment outcome