Abstract 176: Clinical and Imaging Characteristics Associated With Poor Outcomes in Patients Not Thrombolysed Due to Mild or Rapidly Improving Symptoms
Introduction: Several studies have reported poor outcomes in patients “too good to treat” with tPA (TGTT) due to mild or rapidly improving symptoms. We sought to evaluate clinical and imaging factors associated with poor outcomes in these patients
Methods: Using our institutional GWTG stroke registry, we analyzed 4,745 consecutive stroke admissions (2009-2015). Univariate and multivariable analysis determined factors associated with poor outcome (i.e., not being discharged home).
Results: Of the total 4,745 patients, there were 380 TGTT patients’ symptoms. Of these, 67.8% were discharged home, 25.1% to inpatient rehabilitation, 4.2% to a skilled nursing facility and 2.9% expired/hospice. Patients with poor outcome were older, more often Hispanic had more vascular risk factors and higher median NIHSS. Imaging characteristics associated with poor outcomes included large, multifocal or insular infarcts and proximal occlusion or poor collaterals. In multivariable analysis, age, Hispanic ethnicity, diabetes, NIHSS, and infarct distribution (posterior/anterior+posterior) remained significant.
Conclusion: A substantial percentage of patients deemed “too good” for IV tPA were unable to be discharged home. Factors such as advanced age, stroke risk factors, higher NIHSS and infarct location independently predicted poor outcome in patients who are considered TGTT and could be considered in tPA decision-making to optimize outcomes.
Author Disclosures: S.F. Ali: None. K. Siddiqui: None. Y. Shinohara: None. H. Ay: None. A. Singhal: None. A. Viswanathan: None. S. Silverman: None. N. Rost: None. M. Lev: None. L. Schwamm: None.
- © 2016 by American Heart Association, Inc.