title: Predictors of long-term outcome after intravenous or intra-arterial recombinant tissue plasminogen activator treatment in the eastern Hungarian thrombolysis database.
abstract: BACKGROUND
  This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population.
  
  
  METHODS
  Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing.
  
  
  RESULTS
  Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55%. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8%. Outcome was significantly worse, and SICH was more frequent in intra-arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤ 2), and 23% were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year.
  
  
  CONCLUSIONS
  Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.
authors.affiliation: Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary.
authors.forename: Klára
authors.initials: K
authors.lastname: Fekete
authors.affiliation: Department of Sociology and Social Politics, Institute of Political Sciences and Sociology, Faculty of Arts and Humanities, University of Debrecen, Hungary.
authors.forename: Sándor
authors.initials: S
authors.lastname: Márton
authors.affiliation: Diagnoscan Ltd, Debrecen, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Tóth
authors.affiliation: Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Csiba
authors.affiliation: Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Fekete
authors.affiliation: Department of Neurology, Semmelweis University, Budapest, Hungary. Electronic address: bereczki@neur.sote.hu.
authors.forename: Dániel
authors.initials: D
authors.lastname: Bereczki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ischemic stroke; outcome; predictors; thrombolysis