Abstract | BACKGROUND AND PURPOSE: METHODS: We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4-6), and Barthel index >90 at 3 months. RESULTS: Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30-1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45-1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. CONCLUSIONS: The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
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Authors | Gustavo Saposnik, Mathew J Reeves, S Claiborne Johnston, Philip M W Bath, Bruce Ovbiagele, VISTA Collaboration |
Journal | Stroke
(Stroke)
Vol. 44
Issue 10
Pg. 2755-9
(Oct 2013)
ISSN: 1524-4628 [Electronic] United States |
PMID | 23887844
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Fibrinolytic Agents
- Tissue Plasminogen Activator
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Topics |
- Aged
- Aged, 80 and over
- Brain Ischemia
(drug therapy, mortality)
- Clinical Trials as Topic
- Databases, Factual
- Female
- Fibrinolytic Agents
(therapeutic use)
- Humans
- Internet
- Male
- Middle Aged
- Models, Biological
- Predictive Value of Tests
- Risk Factors
- Stroke
(drug therapy, mortality)
- Thrombolytic Therapy
- Tissue Plasminogen Activator
(therapeutic use)
- Treatment Outcome
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