The Factors That Affect The Clinical Outcomes Of Acute Ischemic Stroke Patients Treated With Intravenous Recombinant Tissue Plasminogen Activator

Objectives To investigate factors that may influence the clinical outcomes of acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator(rt-PA).Methods We collected data from the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China(TIMS-China) registry. 1128 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis(IVT) within 4.5 hours and completed the follow-up information were included. We followed up the patients at 3 month for clinical outcomes of symptomatic intracranial hemorrhage(SICH), death and favorite functional outcome(Mrs<2 score). The univariable and multivariable logistic regression were used to analyse the independent factors of prognosis in acute ischemic stroke patients with thrombolysis.Results Among the 1105 patients included in this study, 643(58.19%) had a favorite functional outcome, 61(5.52%) had SICH, and 115(10.41%) were deceased at the 3-month follow-up. After adjustment for potential factors, we found that baseline systolic blood pressure(OR 0.883, 95% CI 0.796-0.979, P=0.0185), National Institutes of Health Stroke Scale(NIHSS) score upon admission(OR 0.859, 95% CI 0.835-0.883, P<0.0001), systolic blood pressure at 24 h after IVT(OR 0.849, 95% CI 0.760-0.949, P=0.0038), early neurologic improvement(ENI) at 2 hours(OR 5.566, 95% CI 3.771-8.216, P<0.0001) were independently associated with favorite functional outcome; INR upon admission(OR 10.169, 95% CI 2.278-45.386, P=0.0024), NIHSS upon admission(OR 1.180, 95% CI 1.134-1.227, P<0.0001), history of stroke(OR 2.143, 95% CI 1.194-3.844, P=0.0099), ENI at 24 hours(OR 0.100, 95% CI 0.040-0.252, P<0.0001) were independently associated with death after IVT; baseline NIHSS score(OR 1.061, 95% CI 1.001-1.134, P=0.0408), history of stroke(OR 4.816, 95% CI 1.751-13.250, P=0.0023), TOAST classification(OR 13.441, 95% CI 3.131-57.705, P=0.0005) were independently associated with SICH after IVT.Conclusions Baseline NIHSS score, baseline INR, systolic blood pressure upon admission and after IVT, history of stroke, TOAST classification, ENI after IVT were independent factors that influenced the prognosis of IVT in patients with acute ischemic stroke.