Intravenous thrombolysis and three-year ischemic stroke mortality

Abstract

Background and purpose: Intravenous thrombolysis (IVT) in ischemic stroke (IS) does not reduce three-month mortality; however, longer-term survival after IVT has not been clearly established. Thus, we aimed to compare three-year mortality after IS in IVT-treated vs non-treated patients and to indicate predictors of long-term mortality after IVT.

Methods: We have evaluated data of 366 subjects with IS (196 treated with IVT and 170 non-treated with IVT, whose age, sex, and calendar time of IS occurrence matched the control group) collected via the Pomeranian Stroke Register. We estimated the three-year survival and its determinants in both groups.

Results: In univariate analysis, IVT was not associated with three-year mortality (OR 0.68; 95% CI 0.44-1.05). Independent predictors for unfavorable long-term outcome in a Cox regression model were older age, parenchymal hemorrhage type 2 (ph2), and modified Rankin scale >2 points at discharge from the hospital. IVT was strongly associated with a lower risk of death in the period 0-36 months from IS (HR 0.44, 95% CI 0.28-0.69, P<.001).

Conclusions: Treatment of IS with intravenous recombinant tissue plasminogen activator was associated with increased survival during the three-year follow-up.

Keywords: ischemic stroke; long-term survival; thrombolysis.