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Nian-Tong Lin, Ying-Chun Cao, Zheng-Zheng Cheng, Yuan Wang, Ping-Yi Xu Department of Neurology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong, China. Aim: The rate of thrombolysis in Chinese acute ischemic stroke (AIS) was low and little was known about the long-term outcome. We aimed to compare the prognosis between thrombolysis and ordinary anti-platelet strategies in AIS. Methods: Patients, who were consecutively registered in our hospital from January 2005 to June 2012, were retrospectively studied. Inclusion criteria: (1) primary diagnoses of cerebral infarction coded with implantable cardioverter defibrillator-10 I63 to I69; (2) symptoms onset to treatment time (OTT) within 6 h; (3) thrombolysis with alteplase (TROM) or ordinary anti-platelet therapy (ANTP). Exclusion criteria: (1) symptoms and signs diminished rapidly without apparent neurological deficits; (2) no visible lesions on diffusion weighted image in magnetic resonance imaging; (3) cerebral infarction caused by serious metabolic in-balance or infections. The endpoints were defined as favorable (modified Rankin Scale 0-2) or being survival. Proportions of favorable outcome or survival were estimated by Kaplan-Meier curve and Cox regression. Results: One hundred and sixty eight cases were analyzed. Ninety one were in TROM and 77 in ANTP. Male accounted for 82 (48.8%) and female 86 (51.2%). The median of age was 74 [interquartile range (IQR) 6779], national institute of health stroke scale (NIHSS 9) (IQR 5-17) and OTT 3.9 h (IQR 3.0-4.8) respectively. The median length of follow-up was 112 (IQR 63.4-163.8) weeks. By the end of December 31, 2012, 87 patients (51.8%) reached favorable outcome while 81 (48.2%) unfavorable. Forty five (26.8%) cases deceased. Kaplan-Meier curve estimation showed a longer favorable period of time in TROM than those in ANTP (212 weeks 95% confidence interval (CI) 169.5-254.5 vs. 126.9 weeks 95% CI 105.2148.6; Log-Rank test x2 = 19.632, P = 0.000), while no significance was seen in survival time (258.0 weeks 95% CI 231.5-284.5 vs. 160.8 weeks 95% CI 153.0-168.5; Log-Rank test x2 = 2.427, P = 0.119). In Cox regression, thrombolysis showed an independent protective effect for longer period of favorable outcome [202 vs. 151 weeks, P = 0.026, heart rate (HR) 1.96, 95% CI 1.958-3.540] and longer survival time instead (333 vs. 170 weeks, P = 0.000, HR 4.322, 95% CI 1.942-9.618). The estimated proportion of favorable outcome in Chinese urban AIS was about 91% for 1 year and 50% for about 3.4 years, while the estimated proportion of survival was about 98.5% for 1 year and 50% for about 5.3 years, respectively. Conclusion: Chinese urban AIS patients who underwent thrombolysis with alteplase might have a better long-term outcome than those receiving ordinary anti-platelet therapy.

Thrombolysis lead to better long-term outcome in Chinese stroke patients