Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke

Jay Chol Choi, Min Uk Jang, Kyusik Kang, Jong Moo Park, Youngchai Ko, Soo Joo Lee, Jae Kwan Cha, Dae Hyun Kim, Sang Soon Park, Tai Hwan Park, Kyung Bok Lee, Jun Lee, Joon Tae Kim, Ki Hyun Cho, Kyung Ho Yu, Mi Sun Oh, Byung Chul Lee, Yong Jin Cho, Dong Eog Kim, Ji Sung LeeJuneyoung Lee, Philip B. Gorelick, Hee Joon Bae

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients. Methods and Results-Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95% CIs of IVT were estimated for 3-month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively. Conclusions-In this observational registry-based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.

Original languageEnglish
Article numbere001306
JournalJournal of the American Heart Association
Volume4
Issue number1
DOIs
Publication statusPublished - 2015 Jan 1

Fingerprint

Standard of Care
Stroke
Propensity Score
Odds Ratio
Registries
National Institutes of Health (U.S.)
Databases
Population

Keywords

  • Ischemic stroke
  • Outcome
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke. / Choi, Jay Chol; Jang, Min Uk; Kang, Kyusik; Park, Jong Moo; Ko, Youngchai; Lee, Soo Joo; Cha, Jae Kwan; Kim, Dae Hyun; Park, Sang Soon; Park, Tai Hwan; Lee, Kyung Bok; Lee, Jun; Kim, Joon Tae; Cho, Ki Hyun; Yu, Kyung Ho; Oh, Mi Sun; Lee, Byung Chul; Cho, Yong Jin; Kim, Dong Eog; Lee, Ji Sung; Lee, Juneyoung; Gorelick, Philip B.; Bae, Hee Joon.

In: Journal of the American Heart Association, Vol. 4, No. 1, e001306, 01.01.2015.

Research output: Contribution to journalArticle

Choi, JC, Jang, MU, Kang, K, Park, JM, Ko, Y, Lee, SJ, Cha, JK, Kim, DH, Park, SS, Park, TH, Lee, KB, Lee, J, Kim, JT, Cho, KH, Yu, KH, Oh, MS, Lee, BC, Cho, YJ, Kim, DE, Lee, JS, Lee, J, Gorelick, PB & Bae, HJ 2015, 'Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke', Journal of the American Heart Association, vol. 4, no. 1, e001306. https://doi.org/10.1161/JAHA.114.001306
Choi, Jay Chol ; Jang, Min Uk ; Kang, Kyusik ; Park, Jong Moo ; Ko, Youngchai ; Lee, Soo Joo ; Cha, Jae Kwan ; Kim, Dae Hyun ; Park, Sang Soon ; Park, Tai Hwan ; Lee, Kyung Bok ; Lee, Jun ; Kim, Joon Tae ; Cho, Ki Hyun ; Yu, Kyung Ho ; Oh, Mi Sun ; Lee, Byung Chul ; Cho, Yong Jin ; Kim, Dong Eog ; Lee, Ji Sung ; Lee, Juneyoung ; Gorelick, Philip B. ; Bae, Hee Joon. / Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke. In: Journal of the American Heart Association. 2015 ; Vol. 4, No. 1.
@article{7d5bc6c35e9b40db9310a6689d360a00,
title = "Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke",
abstract = "Background: One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients. Methods and Results-Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95{\%} CIs of IVT were estimated for 3-month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0{\%}) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95{\%} CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively. Conclusions-In this observational registry-based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.",
keywords = "Ischemic stroke, Outcome, Thrombolysis",
author = "Choi, {Jay Chol} and Jang, {Min Uk} and Kyusik Kang and Park, {Jong Moo} and Youngchai Ko and Lee, {Soo Joo} and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Park, {Sang Soon} and Park, {Tai Hwan} and Lee, {Kyung Bok} and Jun Lee and Kim, {Joon Tae} and Cho, {Ki Hyun} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Lee, {Byung Chul} and Cho, {Yong Jin} and Kim, {Dong Eog} and Lee, {Ji Sung} and Juneyoung Lee and Gorelick, {Philip B.} and Bae, {Hee Joon}",
year = "2015",
month = "1",
day = "1",
doi = "10.1161/JAHA.114.001306",
language = "English",
volume = "4",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke

AU - Choi, Jay Chol

AU - Jang, Min Uk

AU - Kang, Kyusik

AU - Park, Jong Moo

AU - Ko, Youngchai

AU - Lee, Soo Joo

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Park, Sang Soon

AU - Park, Tai Hwan

AU - Lee, Kyung Bok

AU - Lee, Jun

AU - Kim, Joon Tae

AU - Cho, Ki Hyun

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Lee, Byung Chul

AU - Cho, Yong Jin

AU - Kim, Dong Eog

AU - Lee, Ji Sung

AU - Lee, Juneyoung

AU - Gorelick, Philip B.

AU - Bae, Hee Joon

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients. Methods and Results-Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95% CIs of IVT were estimated for 3-month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively. Conclusions-In this observational registry-based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.

AB - Background: One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients. Methods and Results-Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95% CIs of IVT were estimated for 3-month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively. Conclusions-In this observational registry-based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.

KW - Ischemic stroke

KW - Outcome

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=85016503837&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016503837&partnerID=8YFLogxK

U2 - 10.1161/JAHA.114.001306

DO - 10.1161/JAHA.114.001306

M3 - Article

C2 - 25628404

AN - SCOPUS:85016503837

VL - 4

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 1

M1 - e001306

ER -