Abstract 2: Thrombolytic Therapy and Survival for Medicare Beneficiaries with Acute Ischemic Stroke
Background: Thrombolytic therapy (tPA) is the only fibrinolytic agent used in the treatment of acute ischemic stroke. It is recommended due to its ability to achieve early reperfusion and improve neurologic outcomes. This study assesses the survival outcome of tPA use among Medicare beneficiaries with acute ischemic stroke in the Paul Coverdell National Acute Stroke Registry (PCNASR).
Methods: A total of 24,625 patients with a clinical diagnosis of acute ischemic stroke enrolled in the PCNASR from January 2008-December 2010 were linked to MEDPAR 2008-2010 database. Patients with documented reasons for not giving tPA (intravenous and/or intra-arterial) were excluded. A propensity score 1:1 matched-pair sample was created to assess survival among patients receiving tPA and not receiving tPA. The probability of survival was estimated by the Kaplan-Meier method and was compared by the test described by Klein and Moeschberger. The hazard ratio was obtained by using Cox proportional hazard regression model stratified on matched pairs.
Results: A total of 3370 matched patients were selected based on age, gender, race, National Institutes of Health Stroke Scale (NIHSS), medical history of atrial fibrillation, diabetes, heart failure, smoking, prior stroke and myocardial infarction or coronary disease. Patients who received tPA had better survival than patients with no tPA (p=0.0109). The adjusted hazard ratios were 0.84, [0.72, 0.98], 0.86 [0.75, 0.99] and 0.84 [0.74, 0.96] for 30-days, 90-days and one-year survival, respectively. Limitation: In the absence of direct identifiers, the linked datasets might contain possible incorrect information.
Conclusion: This analysis found approximately 15% improved short and long term survival among patients receiving tPA for acute ischemic stroke in a non-clinical trial setting.
- © 2012 by American Heart Association, Inc.