Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator

Abstract

Background Thrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA. Methods One hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale (mRS) score, good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression. Results Of the 101 patients studied, patients in good outcome group (n=55) were significantly younger than patients in poor outcome group (n=46, (62.82±14.25) vs. (68.81±9.85) years, P=0.029). Good outcome group had fewer patients with diabetic history (9.09% vs. 28.26%, P=0.012), fewer patients with leukoaraiosis (7.27% vs. 28.26%, P=0.005) and presented with lower blood glucose level ((5.72±1.76) vs. (6.72±1.32) mmol/L, P=0.012), lower systolic blood pressure level ((135.45±19.36) vs. (148.78±19.39) mmHg, P=0.003), lower baseline NIHSS score (12.02±5.26 vs. 15.78±4.98, P=0.002) and shorter onset-to-treatment time (OTT) ((2.38±1.21) vs. (2.57±1.03) hours, P=0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history (odds ratio (OR) 0.968 (95% CI 0.941-0.996)), absence of leukoaraiosis (OR 0.835 (95% CI 0.712-0.980)), lower baseline NIHSS score (OR 0.885 (95% CI 0.793-0.989)), lower pre-thrombolysis systolic blood pressure (OR 0.962 (95% CI 0.929-0.997)), and lower blood glucose level (OR 0.699 (95% CI 0.491-0.994)) before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolysis have a better outcome.