Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis

Abstract

Background and Purpose— Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. Methods— We conducted a register-based nationwide propensity score–matched follow-up study among patients with ischemic stroke in Denmark (2004–2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes. Results— Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score–matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49–0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68–1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24–1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients. Conclusions— Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

“…Reperfusion therapy, as carried out in all the patients in the current study, improves the short- and long-term outcomes [3,21,26], yet 2 previous studies demonstrated a high mortality rate after IVT within 5 years [22,23], similar to those observed in the present study (41.8%). For short-term follow-up, we report comparable survival data to those previously reported; 76% at 1 year, 66% at 3 years, and 53% at 4 years [21].…”

“…In contrast to previous studies, our study did not demonstrate the impact of seizures, admission NIHSS, or age on mortality. In the present study, patients were younger [21,22,23,26], had only a few cases of seizures, and their Rankin score at 3 months was not factored into the survival. This could explain some of the differences between this study and former studies.…”

Five-Year Outcome in Stroke Patients Submitted to Thrombolysis

“…Studies with long-term follow-up (1-4 years) reported a cumulative mortality of 15% to 53% after IVT. [2][3][4][5][6] Only 3 studies 4-6 had follow-up >12 months, and ours is the first to include 5-year follow-up. Prethrombolytic era 5-year mortality in stroke patients admitted to Stroke Units ranged from 45 to 59.1%, 7,8 and despite lower 5-year mortality in our cohort, direct comparison has limited validity.…”

“…Data on longterm outcome is scarce. [2][3][4][5][6] We aimed to assess 5-year outcome after IVT and to identify predictors of excellent outcome and long-term mortality.…”

Successful Reperfusion with Endovascular Therapy Has Beneficial Effects on Long-Term Outcome Beyond 90 Days

“…One retrospective observational study demonstrated that the rate of death between 4 and 36 months was lower in patients with IV-rtPA therapy compared to those without IV-rtPA therapy, regardless of the outcome at discharge [15]. The other study with propensity score-matched analysis revealed that treatment with IV-rtPA associated with long-term outcome, in which the Kaplan-Meier curves demonstrated that the difference of the mortality rate kept widening throughout the observational period [16]. Aoki et al [17] reported that early IV-rtPA improves the long-term outcome independent of 90-day outcomes.…”