title: Unfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study.
abstract: BACKGROUND
  Thrombolysis with alteplase is an effective and safe treatment for acute ischemic stroke (AIS). It is controversial whether the outcome of thrombolysis in cardioembolic stroke is different from that of other stroke subtypes. This study compares the outcomes at 3 months postthrombolysis in Chinese patients with AIS secondary to cardioembolism (CE) to the outcomes of those with large-artery atherosclerosis (LAA).
  
  
  METHODS
  Using the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China (TIMS-China) cohort, we prospectively followed 827 patients treated within 4.5 h of onset symptoms with alteplase as an intravenous thrombolytic agent. CE and LAA were defined according to TOAST criteria. We compared symptomatic intracerebral hemorrhage (SICH), mortality, and functional outcome at 3 months using multivariables logistic regression analysis.
  
  
  RESULTS
  In this cohort, 221 (19.6%) had CE and 606 (53.7%) had LAA. Approximately 2/3 of patients with CE had atrial fibrillation. Symptoms at onset were more severe in patients with CE than in those with LAA (NIHSS, 15.0 vs. 11.0; P < 0.0001); increased rate of SICH (5.9% vs. 0.8%; P < 0.0001); higher mortality (18.6% vs. 10.3%; P = 0.0015); and reduced functional independence (43.6% vs. 55.9%; P = 0.0018) at 3-month follow-up. After adjustment for baseline variables, the clinical outcome of patients with CE was worse than that of patients with LAA (OR, 0.62; 95% CI, 0.39 to 0.97, P = 0.0378).
  
  
  CONCLUSIONS
  Patients with cardioembolic stroke had more SICH after thrombolysis, and worse clinical outcome at 3-month follow-up compared with those with LAA. This emphasizes the importance of preventing cardioembolism.
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xin-Gao
authors.identifier: http://orcid.org/0000-0001-9164-7069
authors.initials: XG
authors.lastname: Wang
authors.affiliation: Neurology Department, St George's Hospital, London, UK.
authors.forename: Li-Qun
authors.initials: LQ
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Liao
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yue-Song
authors.initials: YS
authors.lastname: Pan
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yu-Zhi
authors.initials: YZ
authors.lastname: Shi
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Chun-Juan
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yi-Long
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Li-Ping
authors.initials: LP
authors.lastname: Liu
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Xing-Quan
authors.initials: XQ
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Wang
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA, USA.
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.|China National Clinical Research Center for Neurological Diseases, Beijing, China.|Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.|Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
authors.forename: Chun-Xue
authors.initials: CX
authors.lastname: Wang
mesh_terms: D000368:Aged; D044466:Asian People; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D020766:Intracranial Embolism / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: Cardioembolism; Large-artery atherosclerosis; Outcome; Stroke subtypes; Symptomatic intracerebral hemorrhage; Thrombolysis