Junya Aoki1, Kazumi Kimura2, Yuki Sakamoto2. 1. Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Japan; Department of Stroke Medicine, Kawasaki Medical School, Japan. Electronic address: aokijy@gmail.com. 2. Department of Neurological Science, Nippon Medical School Graduate School of Medicine, Japan; Department of Stroke Medicine, Kawasaki Medical School, Japan.
Abstract
BACKGROUND AND PURPOSE: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5years after tPA therapy and investigated factors related to long-term clinical outcomes. METHODS: Telephone interviews or interview letters were used to assess the modified Rankin Scale (mRS) scores at 3months, 6months, 1year, 2years, 3years, 4years, and 5years after tPA therapy. Favorable outcome was defined as mRS 0-2. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5years after tPA therapy. RESULTS: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males; median National Institutes of Health Stroke Scale score, 11 [5-18]) patients were enrolled. Kaplan-Meier curve showed that favorable outcomes after 5years after tPA therapy occurred in 45% of the patients and that the mortality rate was 40%. Univariate analysis showed that onset-to-treatment time (OTT) was 121 (107-172) minutes in patients with favorable outcomes and 156 (126-171) minutes in patients with unfavorable outcomes (p=0.016). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.96, 95% confidence interval 0.93-0.99, p=0.004) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). CONCLUSION: Early tPA administration can improve long-term clinical outcomes.
BACKGROUND AND PURPOSE: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5years after tPA therapy and investigated factors related to long-term clinical outcomes. METHODS: Telephone interviews or interview letters were used to assess the modified Rankin Scale (mRS) scores at 3months, 6months, 1year, 2years, 3years, 4years, and 5years after tPA therapy. Favorable outcome was defined as mRS 0-2. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5years after tPA therapy. RESULTS: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males; median National Institutes of Health Stroke Scale score, 11 [5-18]) patients were enrolled. Kaplan-Meier curve showed that favorable outcomes after 5years after tPA therapy occurred in 45% of the patients and that the mortality rate was 40%. Univariate analysis showed that onset-to-treatment time (OTT) was 121 (107-172) minutes in patients with favorable outcomes and 156 (126-171) minutes in patients with unfavorable outcomes (p=0.016). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.96, 95% confidence interval 0.93-0.99, p=0.004) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). CONCLUSION: Early tPA administration can improve long-term clinical outcomes.