title: The Association between t-PA Administration and In-Hospital Mortality following Acute Ischemic Stroke in Puerto Rican Patients.
abstract: OBJECTIVE
  Despite being the standard of care, thrombolytic therapy with tissue plasminogen activator (t-PA) is currently administered to only 5% of acute ischemic stroke (AIS) patients in the United States. Published scientific information regarding both the use of t-PA for AIS in Hispanic patients and its impact on short-term mortality is scarce. The objectives of this study are to investigate, among Puerto Rican patients hospitalized with AIS, the rate of t-PA administration, and the risk of in-hospital mortality in patients who received t-PA vs. those patients who did not receive t-PA.
  
  
  METHODS
  We performed a secondary analysis of data from patients with AIS admitted to acute care facilities throughout Puerto Rico in study years 2007, 2009, and 2011who were participating in the Puerto Rico Cardiovascular Disease Surveillance System. Multivariate logistic regression was used to determine the independent association between treatment with t-PA within 4.5 hours of symptom onset and in-hospital mortality.
  
  
  RESULTS
  Of the 1968 study patients hospitalized with AIS, 104 (5%) received t-PA treatment. After adjustments for demographic and clinical confounders, patients receiving t-PA had similar odds of in-hospital mortality as patients not receiving t-PA did (OR = 2.49, 95% CI = 0.81-7.66). The receipt of concomitant anticoagulation medication was independently associated with relatively lower odds of in-hospital mortality (OR = 0.42, 95% CI = 0.20-0.88). Being over 80 years of age (OR = 2.03, 95% CI = 1.13-3.68), being obese (OR = 1.88, 95% CI = 1.01-3.49), and arriving in an ambulance (OR = 3.61, 95% CI = 1.95-6.68) were all independently associated with relatively higher odds of in-hospital mortality.
  
  
  CONCLUSIONS
  Among patients hospitalized in Puerto Rico with acute ischemic stroke, t-PA treatment was not significantly associated with in-hospital mortality.
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kohrman
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Suehyb
authors.initials: S
authors.lastname: Alkhatib
authors.affiliation: University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Juan
authors.initials: J
authors.lastname: González
authors.affiliation: University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
authors.forename: Fernando
authors.initials: F
authors.lastname: Santiago
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Marcia
authors.initials: M
authors.lastname: Varella
authors.affiliation: Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
authors.forename: Juan
authors.initials: J
authors.lastname: Zevallos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011647:Puerto Rico; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute Ischemic Stroke; In-Hospital Mortality; Thrombolytics; Tissue Plasminogen Activator; t-PA