Temporal Trends of Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

Abstract

Background: Intravenous thrombolysis improves functional outcome in patients with acute stroke and frequencies of r-tPA (recombinant tissue-type plasminogen activator) treatment have been increasing over time. We aimed to assess whether functional outcome in r-tPA–treated patients improved over time and to investigate the influence of clinical variables on functional outcome. Methods: We analyzed data of r-tPA–treated patients in the Austrian Stroke Unit Registry from 2006 to 2019. Favorable functional outcome was defined as modified Rankin Scale score of 0 to 2. Frequencies of modified Rankin Scale score of 0 to 2 were assessed for the overall population and in prespecified subgroups; multivariable logistic regression analysis was performed to assess associations of baseline characteristics including clinically relevant interactions, and outcome. Results: Overall, 4865 out of 9409 r-tPA–treated patients (51.7%) achieved favorable functional outcome 3 months post stroke. Between 2006 and 2019, frequencies of favorable functional outcome increased from 45.9% to 56.8%. In multivariable logistic regression analysis, year of treatment (adjusted odds ratio [adjOR], 1.08 [95% CI, 1.01–1.15]) was associated with favorable functional outcome. Stroke severity (National Institutes of Health Stroke Scale, adjOR, 0.86 [95% CI, 0.85–0.87]), age (61–70 years: adjOR, 0.67 [95% CI, 0.55–0.80], 71–80 years: adjOR, 0.42 [95% CI, 0.35–0.50], >80 years: adjOR, 0.16 [95% CI, 0.13–0.20]), female sex (adjOR, 0.89 [95% CI, 0.79–0.99]), and various comorbidities (eg, atrial fibrillation, prior stroke, diabetes) were negatively associated. Inclusion of interaction terms into the multivariable logistic regression model suggests a positive effect of year of treatment and endovascular treatment by increasing stroke severity on functional outcome (interaction between year of treatment and National Institutes of Health Stroke Scale: adjOR, 1.01 [95% CI, 1.00–1.02], interaction between National Institutes of Health Stroke Scale and endovascular treatment: adjOR, 1.02 [95% CI, 1.01–1.03]). Conclusions: Frequencies of favorable functional outcome in r-tPA–treated patients have been increasing over time, likely driven by improved outcome in patients with more severe strokes receiving endovascular treatment. However, some subgroups are still less likely to achieve functional independency and deserve particular attention.

Telemedical stroke care significantly improves patient outcome in rural areas: Long-term analysis of the German NEVAS network

“…Furthermore, two other studies conducted in the same time period also showed an improvement of 2–3% in clinical outcome of IVT-treated stroke patients. 14 , 15 Thus, the gradual improvement in good clinical outcome can mostly be contributed to the NEVAS network.…”

Trends of Sex Differences and Associated Factors in Stroke Outcomes Among Patients With Acute Ischemic Stroke

“…4,5 However, it is unclear whether there have been temporal changes in sex-based differences in stroke outcomes and particularly whether disparities have narrowed, especially in light of the increasing recognition of sex disparities in recent years. Previous studies usually examined either the overall trends of outcomes after ischemic stroke without differentiation between sexes 6,7 or the overall effect of sex on outcomes without analysis of historical trends. 8 Thus, a thorough and systematic assessment of recent trends in sex-based disparities for ischemic stroke outcomes will be key in the context of ongoing quality improvement efforts in clinical care.…”

Serum biomarkers to predict hemorrhagic transformation and ischemic stroke outcomes in a prospective cohort study

“…Ischemic stroke remains one of the most frequent causes of death and disability worldwide [ 1 ], placing a significant burden on patients and their families, and society as a whole. The actuality of stroke research is driven by the alarming trend of increasing incidence and prevalence rates [ 2 ] in the context of heterogeneity of risk factors and multiple stroke mimics [ 3 ], but also of limited time window available to save the affected brain parenchyma affected by the reduced blood supply [ 4 ]. Moreover, the paucity of time and treatment options for cerebral vessel recanalization faces numerous contraindications and complications, with hemorrhagic transformation (HT) being one the most feared side effect of both chemical and mechanical thrombolysis [ 5 ].…”