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TRENDS OF FUNCTIONAL OUTCOME IN ACUTE STROKE PATIENTS TREATED WITH INTRAVENOUS THROMBOLYSIS – AN ANALYSIS OF THE AUSTRIAN STROKE UNIT REGISTRY
Background and Aims
Intravenous thrombolysis substantially improves outcome in patients with acute stroke. Over time the use of rtPA has been increasing. We aim to assess whether there is an associated trend of increasing frequencies of good functional outcome in rtPA-treated patients.
We analyzed data of rtPA-treated patients during the period of 2006-2019 in the Austrian Stroke Unit Registry. Frequencies of good functional outcome, defined as modified Rankin Scale (mRS) 0-2, were assessed for the overall population and prespecified subgroups; logistic regression analysis was calculated to assess associations of baseline characteristics and outcome.
In 9409 patients who were treated with rtPA between 2006 and 2019, frequencies of good functional outcome increased from 45.9% to 57.0%. Patients >70 years, patients with wake-up stroke/unknown time from symptom onset and patients without atrial fibrillation showed a more pronounced increase. We observed lower numbers of mRS 0-2 in women compared to men during the whole study period. On logistic regression analysis advancing time(OR 1.04, p<0.001) and premorbid independency(OR 6.9, p<0.001) were positively associated with good outcome whereas older age(age 61-70: OR 0.66, p<0.001, age 71-80: OR 0.4, p<0.001, age >80: OR 0.2, p<0.001), moderate-to-severe strokes(OR 0.2, p<0.001), large artery atherosclerosis(OR 0.5, p<0.001) and cardioembolic etiology(OR 0.7, p=0.006), prior stroke(OR 0.8, p=0.024), diabetes mellitus(OR 0.6, p<0.001) and atrial fibrillation(OR 0.7, p<0.001) were negatively associated.
Frequencies of good functional outcome in patients with acute ischemic stroke treated with rtPA have been increasing over time but some subgroups are still less likely to achieve good outcome and deserve particular attention.