Long-Term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolytic Therapy.
OBJECTIVE
It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke.


METHODS
This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013.


RESULTS
After a median follow-up period of 3 years (range, 1-7 years), survival did not differ significantly between the groups; specifically, 56 patients (21.6%) in the thrombolysed group died versus 62 patients (23.94%) in the nonthrombolysed group (log-rank, .240, P = .624). Based on a multivariate Cox proportional hazards regression model, older age (>70 years), stroke severity (National Institutes of Health Stroke Scale score ≥ 15), diabetes mellitus, and a history of atrial fibrillation were independent predictors of long-term mortality after stroke. After the follow-up period, 144 patients (55.6%) in the IVT-treated group versus 112 patients (43.2%) in the control group had an excellent outcome, with a modified Rankin Scale score of 0-1 (hazard ratio [HR] = 1.64, 95% confidence interval [CI] = 1.16-2.32). Based on a multivariate Cox proportional hazards regression model, an excellent 3-month functional recovery was a strong predictor of favorable outcome (HR = 11.27, 95% CI = 6.45-19.63).


CONCLUSIONS
The results suggest that IVT for acute IS has a favorable effect on functional recovery more than 1 year after stroke.
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
Maja
M
Stefanovic Budimkic
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia; Institute of Epidemiology, Belgrade, Serbia.
Tatjana
T
Pekmezovic
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia.
Ljiljana
L
Beslac-Bumbasirevic
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia.
Marko
M
Ercegovac
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia.
Ivana
I
Berisavac
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
Predrag
P
Stanarcevic
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.
Visnja
V
Padjen
Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia. Electronic address: dejana.r.jovanovic@gmail.com.
Dejana R
DR
Jovanović
D061605:Administration, Intravenous; D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D048909:Diabetes Complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins / Q000627:therapeutic use; D020127:Recovery of Function; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
Long-term prognosis; intravenous thrombolysis; predictors of outcome after stroke; stroke