Thrombolysis lead to better long-term outcome in Chinese stroke patients

Aim:The rate of thrombolysis in Chinese acute ischemic stroke(AIS)was low and little was known about the long-term outcome.We aimed to compare the prognosis between thrombolysis and ordinary anti-platelet strategies in AIS.Methods:Patients,who were consecutively registered in our hospital from January 2005 to June 2012,were retrospectively studied.Inclusion criteria:(1)primary diagnoses of cerebral infarction coded with implantable cardioverter defibrillator-10 I63 to I69;(2)symptoms onset to treatment time(OTT)within 6 h;(3)thrombolysis with alteplase(TROM)or ordinary anti-platelet therapy(ANTP).Exclusion criteria:(1)symptoms and signs diminished rapidly without apparent neurological deficits;(2)no visible lesions on diffusion weighted image in magnetic resonance imaging;(3)cerebral infarction caused by serious metabolic in-balance or infections.The endpoints were defined as favorable(modified Rankin Scale 0-2)or being survival.Proportions of favorable outcome or survival were estimated by Kaplan-Meier curve and Cox regression.Results:One hundred and sixty eight cases were analyzed.Ninety one were in TROM and 77 in ANTP.Male accounted for 82(48.8%)and female 86(51.2%).The median of age was 74[interquartile range(IQR)67-79],national institute of health stroke scale(NIHSS 9)(IQR 5-17)and OTT 3.9 h(IQR 3.0-4.8)respectively.The median length of follow-up was 112(IQR 63.4-163.8)weeks.By the end of December 31,2012,87 patients(51.8%)reached favorable outcome while 81(48.2%)unfavorable.Forty five(26.8%)cases deceased.Kaplan-Meier curve estimation showed a longer favorable period of time in TROM than those in ANTP(212 weeks 95%confidence interval(CI)169.5-254.5 vs.126.9 weeks 95%CI 105.2-148.6;Log-Rank test x^(2)=19.632,P=0.000),while no significance was seen in survival time(258.0 weeks 95%CI 231.5-284.5 vs.160.8 weeks 95%CI 153.0-168.5;Log-Rank test x^(2)=2.427,P=0.119).In Cox regression,thrombolysis showed an independent protective effect for longer period of favorable outcome[202 vs.151 weeks,P=0.026,heart rate(HR)1.96,95%CI 1.958-3.540]and longer survival time instead(333 vs.170 weeks,P=0.000,HR 4.322,95%CI 1.942-9.618).The estimated proportion of favorable outcome in Chinese urban AIS was about 91%for 1 year and 50%for about 3.4 years,while the estimated proportion of survival was about 98.5%for 1 year and 50%for about 5.3 years,respectively.Conclusion:Chinese urban AIS patients who underwent thrombolysis with alteplase might have a better long-term outcome than those receiving ordinary anti-platelet therapy.