Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: A retrospective analysis of the get with the guidelines-stroke registry

Jose G Romano, Eric E. Smith, Li Liang, Hannah Gardener, Sara Camp, Laura Shuey, Alison Cook, Iszet Campo-Bustillo, Pooja Khatri, Deepak L. Bhatt, Gregg C. Fonarow, Ralph L Sacco, Lee H. Schwamm

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Abstract

IMPORTANCE: Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke. OBJECTIVE: To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications. INTERVENTION: Intravenous rtPA. MAIN OUTCOMES AND MEASURES: Treatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay. RESULTS: Among 33 995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4%) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8%; life-threatening or serious systemic hemorrhage, 0.2%; other serious complications, 1.8%; and complications of undetermined cause, 2.4%. Mortality was low (1.3%), but at discharge 30.3%could not ambulate independently, 29.4% could not go directly home, and 73.0%had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score. CONCLUSIONS AND RELEVANCE: Many patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.

Original languageEnglish (US)
Pages (from-to)423-431
Number of pages9
JournalJAMA Neurology
Volume72
Issue number4
DOIs
StatePublished - Apr 1 2015

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Registries
Stroke
Guidelines
Tissue Plasminogen Activator
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Length of Stay
Hemorrhage
Ambulances
Complications
Therapeutics
Quality Improvement
Hospital Mortality
African Americans
Walking
Hospital Emergency Service
Mortality

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

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Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis : A retrospective analysis of the get with the guidelines-stroke registry. / Romano, Jose G; Smith, Eric E.; Liang, Li; Gardener, Hannah; Camp, Sara; Shuey, Laura; Cook, Alison; Campo-Bustillo, Iszet; Khatri, Pooja; Bhatt, Deepak L.; Fonarow, Gregg C.; Sacco, Ralph L; Schwamm, Lee H.

In: JAMA Neurology, Vol. 72, No. 4, 01.04.2015, p. 423-431.

Research output: Contribution to journalArticle

Romano, JG, Smith, EE, Liang, L, Gardener, H, Camp, S, Shuey, L, Cook, A, Campo-Bustillo, I, Khatri, P, Bhatt, DL, Fonarow, GC, Sacco, RL & Schwamm, LH 2015, 'Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: A retrospective analysis of the get with the guidelines-stroke registry', JAMA Neurology, vol. 72, no. 4, pp. 423-431. https://doi.org/10.1001/jamaneurol.2014.4354
Romano, Jose G ; Smith, Eric E. ; Liang, Li ; Gardener, Hannah ; Camp, Sara ; Shuey, Laura ; Cook, Alison ; Campo-Bustillo, Iszet ; Khatri, Pooja ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Sacco, Ralph L ; Schwamm, Lee H. / Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis : A retrospective analysis of the get with the guidelines-stroke registry. In: JAMA Neurology. 2015 ; Vol. 72, No. 4. pp. 423-431.
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abstract = "IMPORTANCE: Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke. OBJECTIVE: To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications. INTERVENTION: Intravenous rtPA. MAIN OUTCOMES AND MEASURES: Treatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay. RESULTS: Among 33 995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4{\%}) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8{\%}; life-threatening or serious systemic hemorrhage, 0.2{\%}; other serious complications, 1.8{\%}; and complications of undetermined cause, 2.4{\%}. Mortality was low (1.3{\%}), but at discharge 30.3{\%}could not ambulate independently, 29.4{\%} could not go directly home, and 73.0{\%}had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score. CONCLUSIONS AND RELEVANCE: Many patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30{\%} of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.",
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AU - Gardener, Hannah

AU - Camp, Sara

AU - Shuey, Laura

AU - Cook, Alison

AU - Campo-Bustillo, Iszet

AU - Khatri, Pooja

AU - Bhatt, Deepak L.

AU - Fonarow, Gregg C.

AU - Sacco, Ralph L

AU - Schwamm, Lee H.

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N2 - IMPORTANCE: Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke. OBJECTIVE: To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications. INTERVENTION: Intravenous rtPA. MAIN OUTCOMES AND MEASURES: Treatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay. RESULTS: Among 33 995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4%) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8%; life-threatening or serious systemic hemorrhage, 0.2%; other serious complications, 1.8%; and complications of undetermined cause, 2.4%. Mortality was low (1.3%), but at discharge 30.3%could not ambulate independently, 29.4% could not go directly home, and 73.0%had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score. CONCLUSIONS AND RELEVANCE: Many patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.

AB - IMPORTANCE: Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke. OBJECTIVE: To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications. INTERVENTION: Intravenous rtPA. MAIN OUTCOMES AND MEASURES: Treatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay. RESULTS: Among 33 995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4%) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8%; life-threatening or serious systemic hemorrhage, 0.2%; other serious complications, 1.8%; and complications of undetermined cause, 2.4%. Mortality was low (1.3%), but at discharge 30.3%could not ambulate independently, 29.4% could not go directly home, and 73.0%had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score. CONCLUSIONS AND RELEVANCE: Many patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.

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