Abstract W MP33: Baseline Clinical and Infarct Characteristics as Predictors of Poor Outcomes in Patients Not Thrombolysed Due to Mild or Resolving Symptoms ("Too Good To Treat")

Abstract

Introduction: A common reason for non-treatment of time eligible patients with IV tPA is mild symptoms in patients that are “too good to treat (TGTT)”. Several studies have reported poor outcomes in this group. We sought to identify patient and imaging characteristics associated with poor outcomes in this group. Methods: Using our institutional GWTG database, we analyzed 2,745 consecutive stroke admissions (01/2009 - 07/2013). Univariate and multivariable analysis were carried out to determine factors associated with the poor outcome of not being discharged home. Results: Of the total 2,745 patients, 306 (11.1%) presented within the window for IV tPA but did not receive the treatment due to symptoms too mild or rapidly improving. Of these, imaging characteristics were available in 238 patients. Among TGTT stroke patients, 62.6% were discharged home, 26.9% to IRF, 8.4% to SNF and 2.1% death/hospice. Patients with poor outcome were older, more often Hispanic, with more vascular risk factors, and higher NIHSS. Infarcts in both hemispheres, and in posterior+/- anterior circulation were more common with poor outcome. On multivariable analysis, increasing age, Hispanic ethnicity, higher NIHSS and bihemispheric stroke were associated with poor outcome, with a trend toward small vessel stroke subtype. Conclusion: A substantial percentage of patients deemed “too good” for IV tPA are still unable to be discharged home. Factors such as advanced age, higher NIHSS, bi-hemispheric infarction should be considered in tPA decision-making in potential TGTT patients. Large, multi-center prospective studies are needed to better identify potential biomarkers of poor outcomes in this group.