Open AccessUnfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study
Author(s) -
Wang XinGao,
Zhang LiQun,
Liao XiaoLing,
Pan YueSong,
Shi YuZhi,
Wang ChunJuan,
Wang YiLong,
Liu LiPing,
Zhao XingQuan,
Wang YongJun,
Li Dong,
Wang ChunXue
Publication year - 2015
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.12421
Subject(s) - medicine , thrombolysis , atrial fibrillation , stroke (engine) , intracerebral hemorrhage , cohort , cardiology , prospective cohort study , logistic regression , cohort study , myocardial infarction , subarachnoid hemorrhage , mechanical engineering , engineering
Summary Background Thrombolysis with alteplase is an effective and safe treatment for acute ischemic stroke ( AIS ). It is controversial whether the outcome of thrombolysis in cardioembolic stroke is different from that of other stroke subtypes. This study compares the outcomes at 3 months postthrombolysis in Chinese patients with AIS secondary to cardioembolism ( CE ) to the outcomes of those with large‐artery atherosclerosis ( LAA ). Methods Using the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China ( TIMS ‐China) cohort, we prospectively followed 827 patients treated within 4.5 h of onset symptoms with alteplase as an intravenous thrombolytic agent. CE and LAA were defined according to TOAST criteria. We compared symptomatic intracerebral hemorrhage ( SICH ), mortality, and functional outcome at 3 months using multivariables logistic regression analysis. Results In this cohort, 221 (19.6%) had CE and 606 (53.7%) had LAA . Approximately 2/3 of patients with CE had atrial fibrillation. Symptoms at onset were more severe in patients with CE than in those with LAA ( NIHSS , 15.0 vs. 11.0; P < 0.0001); increased rate of SICH (5.9% vs. 0.8%; P < 0.0001); higher mortality (18.6% vs. 10.3%; P = 0.0015); and reduced functional independence (43.6% vs. 55.9%; P = 0.0018) at 3‐month follow‐up. After adjustment for baseline variables, the clinical outcome of patients with CE was worse than that of patients with LAA ( OR , 0.62; 95% CI , 0.39 to 0.97, P = 0.0378). Conclusions Patients with cardioembolic stroke had more SICH after thrombolysis, and worse clinical outcome at 3‐month follow‐up compared with those with LAA . This emphasizes the importance of preventing cardioembolism.