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From the Stroke Unit, Department of Neurology (Dr. Tanne), Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Clinical Neurosciences (Drs. Demchuk and Hill), Foothills Hospital, Calgary, Canada; Comprehensive Stroke Center (Dr. Kasner), University of Pennsylvania Medical Center, Philadelphia, PA; Park Nicollet Neuroscience (Dr. Hanson), St. Louis Park, MN; Klinik für Neurologie der Universität zu Köln (Dr. Grond), Köln, Germany; Henry Ford Hospital and Health Science Center (Dr. Levine), Detroit, MI.
Address correspondence and reprint requests to Dr. Michael D. Hill, MRG005, Foothills Hospital, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada; email: michael.hill{at}crha-health.ab.ca
Background:— Thrombolytic therapy for acute ischemic stroke with IV alteplase is increasingly well established in North America but not elsewhere. Baseline factors that altered the response to alteplase were not identified by the National Institute of Neurological Disorders and Stroke tPA Stroke Study Group.
Methods:— The authors gathered information from centers in the United States, Canada, and Germany on 1,205 patients with acute ischemic stroke treated with IV alteplase. The purpose was to identify independent factors that were predictive of good outcome using multivariable logistic regression modelling. The modified Rankin Scale score was dichotomized into good outcome (mRS 0 to 1) and poor outcome (mRS >1) as the primary outcome measure.
Results:— In relative order of decreasing magnitude, milder baseline stroke severity, no history of diabetes mellitus, normal CT scan, normal pretreatment blood glucose level, and normal pretreatment blood pressure were independent predictors of good outcome among patients treated with IV alteplase for acute ischemic stroke. Confounding was observed among history of diabetes mellitus, CT scan appearance, baseline serum glucose level, and blood pressure, suggesting important relationships among these variables.
Conclusions:— Several factors were independently predictive of good outcome among patients with acute ischemic stroke treated with alteplase. These results require further confirmation before clinical implementation.
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