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Comparison of Outcomes after Reperfusion Therapy between In-Hospital and Out-of-Hospital Stroke Patients

Authors
 Yoo J.  ;  Song D.  ;  Lee K.  ;  Kim Y.D.  ;  Nam H.S.  ;  Heo J.H. 
Citation
 CEREBROVASCULAR DISEASES, Vol.40(1~2) : 28-34, 2015 
Journal Title
 CEREBROVASCULAR DISEASES 
ISSN
 1015-9770 
Issue Date
2015
MeSH
Aged ; Comorbidity ; Female ; Fibrinolytic Agents/administration & dosage* ; Fibrinolytic Agents/adverse effects ; Hospital Mortality ; Hospitals, University ; Humans ; Infusions, Intra-Arterial ; Infusions, Intravenous ; Inpatients* ; Male ; Middle Aged ; Patient Admission ; Registries ; Retrospective Studies ; Risk Factors ; Stroke/diagnosis ; Stroke/mortality ; Stroke/therapy* ; Thrombolytic Therapy*/adverse effects ; Thrombolytic Therapy*/methods ; Thrombolytic Therapy*/mortality ; Time Factors ; Time-to-Treatment ; Treatment Outcome
Keywords
Stroke ; Cerebral infarction ; Thrombolysis ; Treatment outcome ; In-hospital mortality ; Reperfusion therapy
Abstract
BACKGROUND: Patients may experience stroke while being admitted to the hospital (in-hospital stroke (IHS)) and they may be important candidates for reperfusion therapy. IHS patients may have various comorbidities and show worse outcomes compared with patients with an out-of-hospital stroke (OHS). On the other hand, the time from onset to treatment may be shorter in IHS patients than OHS patients. Most outcome studies of reperfusion therapy have been based on findings in OHS patients, and little information is currently available regarding outcomes of IHS, whether the outcomes differ between patients with IHS and those with OHS who receive reperfusion therapy. METHODS: This is a retrospective observational study using prospectively registered data. Consecutive patients who underwent the reperfusion therapy (intravenous (IV), intra-arterial (IA), or combined IV and IA) between July 2002 and June 2014 in a university hospital were included for this study. We compared the demographics, time interval from symptom onset to treatment, and outcomes between IHS and OHS patients and analyzed the factors associated with in-hospital mortality. RESULTS: A total of 686 patients received the reperfusion therapy during the study period. Of them, 256 (37.3%) patients received the IV tissue plasminogen activator (t-PA) therapy only, 243 (35.4%) patients received the IA therapy only, and 187 (27.3%) patients received the combined IV and IA therapy. Among these, 104 (15.2%) were IHS patients. The time intervals from symptom onset to IV t-PA administration (87.5 ± 48.4 vs. 113.4 ± 38.3 min, p < 0.001) and IA puncture (221.8 ± 195.0 vs. 343.6 ± 155.4 min, p < 0.001) were shorter for IHS than OHS. The rates of successful recanalization and symptomatic intracerebral hemorrhage, and the favorable functional outcome at 3 months were similar between the groups. In-hospital all-cause mortality was higher in IHS than OHS (16.3 vs. 8.4%, p = 0.019), but after adjustment, IHS was not an independent factor. The stroke mortality did not differ between the groups (9.6 vs. 6.9%, p = 0.432). CONCLUSIONS: Although IHS patients more frequently had comorbid diseases and higher overall in-hospital mortality, the standard outcomes of the reperfusion therapy were similar between IHS and OHS patients, which might be, in part, ascribed to the shorter interval from symptom onset to treatment in IHS. Considering a substantial portion of IHS patients, we should pay more attention to these patients.
Full Text
http://www.karger.com/Article/FullText/381787
DOI
10.1159/000381787
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Song, Dong Beom(송동범)
Yoo, Joon Sang(유준상)
Lee, Ki Jeong(이기정)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/140315
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