| Purpose:To study the relationship between onset to treatment time(OTT)and prognosis after intravenous thrombolysis with recombinant tissue type plasminogen activator(IV rt-PA)in patients with acute ischemic stroke(AIS)of different severity,further identify the impact of OTT according to stroke severity on functional outcome.Methods:We retrospectively evaluated the patients with AIS treated with IV rt-PA within 6 hours in the neurology department of TianJin Huanhu Hospital from March 2018 to August 2018,and excluded those with initial modified Rankin Scale(mRS)?3.All patients were categorized into 3 groups according to stroke severity at baseline by assessing with the National Institute of Health Stroke Scale(NIHSS): mild stroke(NIHSS?5),moderate stroke(NIHSS 6-15)and severe stroke(NIHSS?16).Each group was divided into sub-groups according to OTT: ?180 minutes,180-270 minutes and 270-360 minutes.The demographic data,stroke risk factors,OTT,baseline NIHSS and NIHSS of 2 hours,24 hours,7 days after thrombolysis respectively,90 day mRS score,the occurrence of symptomatic intracerebral hemorrhage(sICH)or asymptomatic intracerebral hemorrhage(aICH)and death were collected and recorded.The favorite short-term outcome was defined as NIHSS decreasing? 4 or neurological impairments recovering completely(NIHSS=0)after 24 hours and 7 days.The favorable long-term outcome was defined as 90 day mRS?2.We analyzed the prognosis of the patients with different severity and OTT.Results:A total of 317 AIS patients were included in our study,226(71.3%)patients were male,91 patients(28.7%)were femle,mean age was 64.05±10.75 years,median baseline NIHSS score was 9[4-16],mean OTT was 227.90±64.5 min.100 patients(31.5%)had mild,130 patients(41.1%)had moderate,87 patients(27.4%)had severe AIS.In patients with mild AIS,there were 23(23%),43(43%)and 34(34%)patients with OTT?180 min,180-270 min,270-360 min respectively.There was no statistical difference in short-term and long-term outcome among the three groups(P>0.05).There were 1 case of aICH,no sICH and death.At 90 days,93% of the patients achieved a good functional outcome.OTT was unrelated to favorite outcome(P=0.365).In patients with moderate AIS,there were 45(34.6%),56(43.1%)and 29(22.3%)patients in the three subgroups of OTT.There was no statistical difference in short-term outcome among the three groups(P>0.05);whereas the long-term outcome had significant difference(P=0.032).There were 2 case of sICH,2 case of death,no aICH,61.5% of them achieved a good functional outcome.There was a significant association between OTT and long-term outcome(P=0.041),in addition,baseline NIHSS score(P<0.001)was related to functional outcome.In multi-factor analysis,baseline NIHSS(OR=0.689,95% CI: 0.607-0.811;P<0.001),OTT(OR=1.027,95% CI: 1.009-1.121;P=0.020)emerged as independent predictors of favorable long-term outcome.In patients with severe AIS,there were 31(35.6%),40(46.0%)and 16(18.4%)patients in the three subgroups of OTT.There was no statistical difference in short-term and long-term outcome among the three groups(P>0.05).There were 2 case of sICH,2 case of aICH,4 cases died.At 90 days,34.5% of them achieved a good functional outcome.OTT was unrelated to favorite outcome(P=0.548).Conclusion:The impact of OTT on prognosis after IV rt-PA of patients with AIS varied widely depending on baseline stroke severity.In patients with moderate AIS,there was no statistical difference in short-term neurological improvement among different OTT groups,but there was significant difference in long-term functional outcomes.OTT and baseline NIHSS were independent predictors for favorable long-term outcome.However,in patients with mild and severe AIS,there was no statistical difference in short-term neurological improvement and long-term functional outcome among different OTT groups.OTT seemed unrelated to prognosis after IV rt-PA in mild and severe AIS. |
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