TY - JOUR
T1 - Predictors of thrombolysis administration in mild stroke Florida-Puerto Rico collaboration to reduce stroke disparities
AU - Asdaghi, Negar
AU - Wang, Kefeng
AU - Ciliberti-Vargas, Maria A.
AU - Gutierrez, Carolina Marinovic
AU - Koch, Sebastian
AU - Gardener, Hannah
AU - Dong, Chuanhui
AU - Rose, David Z.
AU - Garcia, Enid J.
AU - Burgin, W. Scott
AU - Carlos Zevallos, Juan
AU - Rundek, Tatjana
AU - Sacco, Ralph L.
AU - Romano, Jose G.
N1 - Funding Information:
The Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study is supported by the National Institutes of Health/National Institute of Neurological Disorders and Stroke Prevention and Intervention Research Program cooperative grant (grant No. U54NS081763).
Funding Information:
Dr Sacco is the recipient and the primary investigator of the Stroke Prevention and Intervention Research Program (SPIRP) cooperative grant from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke (NINDS; grant No. U54NS081763). Dr Rundek is the recipient of the women’s supplement from the NIH, Office of Research on Women’s Health (grant No. 3U54NS081763-01S1). Dr Romano receives research salary support from the SPIRP cooperative grant from the NIH/NINDs (grant No. U54NS081763). Dr Koch receives research salary support from the SPIRP cooperative grant from the NIH/NINDS (grant No. U54NS081763). The other authors report no conflicts.
PY - 2018
Y1 - 2018
N2 - Background and Purpose-Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). Methods-Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale =5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis. Results-We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus =3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster doorto-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration. Conclusions-Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke
AB - Background and Purpose-Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). Methods-Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale =5 who arrived within 4 hours of symptom onset. Multilevel logistic regression analysis with generalized estimating equations was used to identify independent predictors of thrombolytic administration in the subgroup of patients without contraindications to thrombolysis. Results-We included 6826 cases (final diagnosis mild stroke, 74.6% and TIA, 25.4%). Median age was 72 (interquartile range, 21); 52.7% men, 70.3% white, 12.9% black, 16.8% Hispanic; and median National Institutes of Health Stroke Scale, 2 (interquartile range, 3). Patients who received thrombolysis (n=1281, 18.7%) were younger (68 versus 72 years), had less vascular risk factors (hypertension, diabetes mellitus, and dyslipidemia), had lower risk of prior vascular disease (myocardial infarction, peripheral vascular disease, and previous stroke), and had a higher presenting median National Institutes of Health Stroke Scale (4 versus 2). In the multilevel multivariable model, early hospital arrival (arrive by 0-2 hours versus =3.5 hours; odds ratio [OR], 8.16; 95% confidence interval [CI], 4.76-13.98), higher National Institutes of Health Stroke Scale (OR, 1.87; 95% CI, 1.77-1.98), aphasia at presentation (OR, 1.35; 95% CI, 1.12-1.62), faster doorto-computed tomography time (OR, 1.81; 95% CI, 1.53-2.15), and presenting to an academic hospital (OR, 2.02; 95% CI, 1.39-2.95) were independent predictors of thrombolysis administration. Conclusions-Mild acutely presenting stroke patients are more likely to receive thrombolysis if they are young, white, or Hispanic and arrive early to the hospital with more severe neurological presentation. Identification of predictors of thrombolysis is important in design of future studies to assess the use of thrombolysis for mild stroke
KW - Florida
KW - Puerto Rico
KW - Risk factors
KW - Stroke
KW - Therapy
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U2 - 10.1161/STROKEAHA.117.019341
DO - 10.1161/STROKEAHA.117.019341
M3 - Article
C2 - 29459397
AN - SCOPUS:85043724821
VL - 49
SP - 638
EP - 645
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 3
ER -