Abstract WP59: IV rt-PA Treatment Response of The STROKE100 Club: Systematic Technique for Risk and Outcome Measurements Using Key Elements Totaling 100.
Background: Advanced age and high NIHSS are independent predictors of poor AIS outcome. While not excluded from IV rtPA, response is debated in these groups. Patients in the “STROKE 100 Club” (AIS with any combination of age + NIHSS ≥100) have worse outcome without increased sICH. Treatment response has not been evaluated. We evaluated 90 day outcome in the “STROKE 100 Club” with or without rt-PA.
Methods: The UCSD SPOTRIAS prospectively collected database was analyzed for “STROKE 100 Club” patients, and all AIS patients either ≥ 80 years old or with NIHSS ≥ 20. Multivariable regression models were used with treatment group as independent variable. Models were adjusted for pre-specified covariates: pre-stroke mRS, diabetes, and atrial fibrillation.
Results: We identified 82 STROKE 100 Club patients; 24 were untreated, 58 received IV rtPA. IV tPA treated patients were less likely to have prior history of stroke (22.8% vs 54.2%, p=0.0089). No treatment difference was seen in discharge destination, death, or poor outcome (mRS 3-6) at 90 days. In patients either ≥ 80 years old or with NIHSS ≥ 20, no difference was seen in 90 day outcomes between IV tPA and untreated patients, controlling for baseline variables. In patients ≥ 80 years old, poor outcome was associated with higher NIHSS (OR 1.16, 95% CI 1.09-1.24, p<0.0001) and mRS 3-6 (OR 5.28, 95% CI 1.64-16.96, p=0.0052). Higher NIHSS was also associated with death (OR 1.11, 95% CI 1.06-1.16, p<0.0001) and discharge to facility (OR 1.17 95% CI 1.10-1.24, p<0.0001).
Conclusions: Prognosis remains a concern in patients with various permutations of stroke severity and advanced age. Patients ≥80 with higher NIHSS had worse outcome, confirming our prior findings in the STROKE 100 club. Interestingly, IV tPA in the STROKE 100 Club did not lead to worse outcome. IV rtPA remains a safe treatment option for patients in the STROKE 100 club. Ongoing analyses may identify subgroups at greater or lesser benefit of thrombolysis. Planned analyses include assessment in a larger NIH-SPOTRIAS cohort.
- © 2012 by American Heart Association, Inc.