title: Early administration of tissue-plasminogen activator improves the long-term clinical outcome at 5years after onset.
abstract: OBJECTIVE
  Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5years after tPA therapy and investigated factors related to long-term clinical outcomes.
  
  
  METHODS
  Telephone interviews or interview letters were used to assess the modified Rankin Scale (mRS) scores at 3months, 6months, 1year, 2years, 3years, 4years, and 5years after tPA therapy. Favorable outcome was defined as mRS 0-2. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5years after tPA therapy.
  
  
  RESULTS
  From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males; median National Institutes of Health Stroke Scale score, 11 [5-18]) patients were enrolled. Kaplan-Meier curve showed that favorable outcomes after 5years after tPA therapy occurred in 45% of the patients and that the mortality rate was 40%. Univariate analysis showed that onset-to-treatment time (OTT) was 121 (107-172) minutes in patients with favorable outcomes and 156 (126-171) minutes in patients with unfavorable outcomes (p=0.016). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.96, 95% confidence interval 0.93-0.99, p=0.004) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001).
  
  
  CONCLUSIONS
  Early tPA administration can improve long-term clinical outcomes.
authors.affiliation: Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Japan; Department of Stroke Medicine, Kawasaki Medical School, Japan. Electronic address: aokijy@gmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Japan; Department of Stroke Medicine, Kawasaki Medical School, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Japan; Department of Stroke Medicine, Kawasaki Medical School, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Favorable outcome; Ischemic stroke; Long-term outcome; Mortality; Onset-to-treatment time; Thrombolysis