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Prediction of long-term outcome by percent improvement after the first day of thrombolytic treatment in stroke patients.

 Hyo Suk Nam  ;  Kyung-Yul Lee  ;  Sang Won Han  ;  Seo Hyun Kim  ;  Jong Yun Lee  ;  Seong Hwan Ahn  ;  Dong Joon Kim  ;  Dong Ik Kim  ;  Chung Mo Nam  ;  Ji Hoe Heo 
 JOURNAL OF THE NEUROLOGICAL SCIENCES, Vol.281(1-2) : 69-73, 2009 
Journal Title
Issue Date
Aged ; Atrial Fibrillation/complications ; Carotid Artery Diseases/complications ; Female ; Fibrinolytic Agents/therapeutic use* ; Humans ; Injections, Intra-Arterial ; Injections, Intravenous ; Male ; Middle Aged ; ROC Curve ; Severity of Illness Index ; Smoking ; Stroke/complications ; Stroke/drug therapy* ; Stroke/physiopathology ; Thrombolytic Therapy* ; Tissue Plasminogen Activator/therapeutic use* ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/therapeutic use*
Ischemic stroke ; Thrombolysis ; Outcome ; ROC curve
BACKGROUND: We investigated a method for assessing early improvement and predictive factors of early and late outcomes in patients receiving thrombolytic therapy. METHODS: A total of 160 consecutive patients who received thrombolytic therapy were included in the study. Using National Institutes of Health Stroke Scale (NIHSS) scores, percent improvement [(baseline NIHSS score-24-hour NIHSS score)/baseline NIHSS score x 100] was calculated and compared with delta (baseline NIHSS score-24-hour NIHSS score) and with major neurological improvement (MNI, NIHSS score of 0-1 or >or=8 point improvement at 24 h) by receiver operating characteristic (ROC) curve analysis. Finally, we investigated the independent predictors of improvement at 24 h after the thrombolytic therapy and of favorable 3-month outcome (modified Rankin scale score 0-2). RESULTS: By pairwise comparison of ROC curves, percent improvement was stronger than delta (p=0.004) and MNI (p<0.001) in predicting long-term outcome. First day improvement (FDI), defined as greater than 20% improvement, was a strong predictor of favorable 3-month outcome (OR 12.55, 95% CI 5.41-29.10). Recanalization (OR 3.30, 95% CI 1.28-8.45), absence of carotid T occlusion (OR 0.09, 95% CI 0.02-0.42) and hemorrhagic transformation (OR 0.25, 95% CI 0.09-0.73) were independent predictors of FDI. Independent predictors of favorable 3-month outcome were FDI, current smoking, absence of carotid T occlusion and hemorrhagic transformation. CONCLUSIONS: Percent improvement at 24 h after thrombolytic therapy is a useful surrogate marker for predicting the long-term outcome. Our findings highlight the importance of early stroke managemen
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Seo Hyun(김서현)
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Ahn, Seong Hwan(안성환)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Lee, Jong Yun(이종윤)
Han, Sang Won(한상원)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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