Abstract 3: Predictors of In-hospital Death in Patients with Acute Ischemic Stroke Treated with Thrombolytic Therapy: Paul Coverdell Acute Stroke Registry 2008-2011
Background: Limited studies exist on the outcome of thrombolytic therapy of acute ischemic stroke patients, especially outside of clinical trials. This study assessed the association between in-hospital death and possible risk factors among patients who received intravenous thrombolytic therapy (IV tPA) in Paul Coverdell Acute Stroke Registry (PCNASR) between January 2008 and December 2011.
Methods: A total of 5,766 patients with a clinical diagnosis of acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS), were treated with IV tPA within 4.5 hours after last well known time (LKW). Generalized estimating equations (GEE) modeling was used to assess the association between in-hospital death and age, gender, race, NIHSS, medical history of hypertension, myocardial infarction (MI) or coronary artery disease (CAD), heart failure (HF), diabetes, atrial fibrillation (AF), smoking and prior stroke.
Results: Among 5,766 patients treated with IV tPA, 432 (7.5%) died. Factors associated with in-hospital death were older age (for each 1-year increment, adjusted odds ratio [AOR], 1.03; 95% CI, 1.02-1.04, p<0.0001), NIH scale score (For each 1-unit increment, AOR, 1.11; 95% CI, 1.09-1.13, p<0.001), and history of MI/CAD (AOR, 1.28, 95% CI, 1.02-1.60, p=0.03). Symptomatic intracranial hemorrhage was observed in 4.7% and life threatening/serious systemic hemorrhage in 0.8% of patients receiving IV tPA. Eighty-three percent of patients received IV tPA within 3 hours of LKW and the rates of in-hospital death and bleeding complications were not different for patients treated within 3 hours and from >3-4.5 hours.
Conclusion: In this study of acute ischemic stroke patients, older age, NIHSS and history of MI/CAD were associated with increased in-hospital death among patients receiving IV tPA.
- © 2012 by American Heart Association, Inc.