Abstract T P14: Multi-modality Treatment of Acute Ischemic Strokes Improves Patient Outcome at Discharge vs Intravenous Tissue Plasminogen Activator
Background and Purpose: Since the introduction of Intravenous Tissue Plasminogen Activator (IV tPA) and mechanical thrombectomy, the management of acute ischemic stroke has advanced. The objective of this analysis is to compare treatment modalities and the outcome among stroke patients.
Methods: This is a retrospective analysis of all patients (n=142) that presented to our hospital with ischemic stroke and received treatment between January 2009 and July 2012. We divided the patients into two groups based on the treatment they received: A) patients received only IV tPA B) patients received both IV tPA and mechanical thrombectomy. Analysis of variance was used to compare the difference of the means between the two groups. Uni- and multivariate logistic regression models were used to compare the association of different treatment modalities with the modified rankin scale (mRS) at discharge. Discharge status was dichotomized based on an mRS greater than 2 as a poor outcome. Multivariate models were created adjusting for age, gender, NIHSS, hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia (HLD). All measurements were done using the SAS software version 9.2.
Results: Group analysis including n, gender, mean age, mean NIHSS and mortality at discharge was as follows: A) 104, 50% female, 73±14, 12±7, 6.73% B) 38, 50% female, 71±14, 18±7, 7.89%. When controlling for age, gender, DM, HTN, and HLD, patients in group B had a better outcome than group A (OR 0.3, 95% CI, 0.09-0.96) despite presenting with a worse NIHSS. There was no difference in mortality between the two groups. There was a significant association between NIHSS at admission and mRS at discharge (OR 1.2, 95% CI, 1.13-1.29). There was also a significant association between having DM and a poor outcome (OR 3.94, 95% CI, 1.37-11.37).
Conclusion: In our patient subset, multi-modality treatment of acute stroke is safe and associated with a better clinical outcome than IV tPA alone at discharge. Further prospective studies are needed to corroborate our findings.
Author Disclosures: H. Dababneh: None. A. Bashir: None. M. Hussain: None. S. Misthal: None. M. Moussavi: None. J.F. Kirmani: None.
- © 2014 by American Heart Association, Inc.