Temporal Trends of Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis. Issue 11 (24th August 2022)

• Record Type: Journal Article
• Authors: Marko, Martha; Miksova, Dominika; Ebner, Johanna; Lang, Marie; Serles, Wolfgang; Sommer, Peter; Sykora, Marek; Lang, Wilfried; Knoflach, Michael; Kiechl, Stefan; Greisenegger, Stefan
• Other Names: Mutzenbach Johannes Sebastian author non-byline.; Bubel Nele author non-byline.; Zellner Thomas author non-byline.; Krstic Miroslav author non-byline.; Grandits Waltraud author non-byline.; Katzenschlager Regina author non-byline.; Vosko Milan R. author non-byline.; von Örzten Tim author non-byline.; Struhal Walter author non-byline.; Brunner Cornelia author non-byline.; Yilmaz-Kaymaz Nilguen author non-byline.; Hosseiny Omid author non-byline.; Krisper Eva author non-byline.; Säckl Felix author non-byline.; Baumgartner Christoph author non-byline.; Rumpl Elke author non-byline.; Pirker-Kees Agnes author non-byline.; Berger Otto author non-byline.; Beirer Sebastian author non-byline.; Komenda-Lett Martin author non-byline.; Weber Jörg R. author non-byline.; Höfner Elmar author non-byline.; Seiler Stephan author non-byline.; Berek Klaus author non-byline.; Mayr Markus author non-byline.; Haaser Stefan author non-byline.; Asenbaum-Nan Susanne author non-byline.; Heumesser Rebecca author non-byline.; Rumpl Barbara Almut author non-byline.; Rus Marc author non-byline.; Muellauer Barbara author non-byline.; Höger Franz author non-byline.; Lampl Christian author non-byline.; Bocksrucker Christof author non-byline.; Lackner Peter author non-byline.; Schlager Markus author non-byline.; Mayer Florian author non-byline.; Fertl Elisabeth author non-byline.; Steiner Sandrina author non-byline.; Koller Herbert author non-byline.; Doppler Wolfgang author non-byline.; Ferrari Julia author non-byline.; Krebs Stefan author non-byline.; Mitrovic Nenad author non-byline.; Salletmayr Thomas author non-byline.; Grunenberg Monika author non-byline.; Bancher Christian author non-byline.; Pinter Hajnalka author non-byline.; Karpat Frantisek author non-byline.; Sellner Johann author non-byline.; Wolf Thomas author non-byline.; Schnider Peter author non-byline.; Wallner-Blazek Mirja author non-byline.; Enzinger Christian author non-byline.; Gattringer Thomas author non-byline.; Poltrum Birgit author non-byline.; Böhme Christian author non-byline.; Mayer Lukas author non-byline.; Hofeneder Dominik author non-byline.; Daniel Gerhard author non-byline.; Kaniak Kitty author non-byline.; Grossmann Josef author non-byline.; Morgenstern Gabi author non-byline.; Wendlinger Nadja author non-byline.; Staykov Dimitre author non-byline.; Halilovic Almin author non-byline.; Frattner Michael author non-byline.; Waiß Christoph author non-byline.; Tinchon Alexander author non-byline.; Fischer Anna author non-byline.; Kapeller Peter author non-byline.; Luschin Gerda author non-byline.; Gasser Sibylle author non-byline.; Heine Martin author non-byline.; Wurzinger Harald author non-byline.; Wührer Susanne author non-byline.; Werner Philipp author non-byline.; Mayr Andrea author non-byline.; Matosevic Benjamin author non-byline.; Gollmer A. author non-byline.; Kern R. author non-byline.;
• Is Part Of: Stroke. Volume 53:Issue 11(2022)
• Page Start: 3329
• Page End: 3337
• Publication Date: 2022-08-24
• Subjects: atrial fibrillation -- Austria -- ischemic stroke -- National Institutes of Health -- odds ratio -- thrombolysis; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.121.038400
• Languages: English
• ISSNs: 0039-2499

Abstract

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.