Correlation Analysis Between The Long-term Outcome Of Intravenous Thrombolysis With Rt-PA And TOAST Classification In Acute Cerebral Infarction

Objective: To investigate correlation between the long-term outcome of intravenous thrombolysis with rt-PA and TOAST classification in acute cerebral infarction and related factors affecting the long-term outcome of different TOAST subtypes.Methods: We consecutively collected general condition and clinical data of 143 patients,who suffered acute cerebral infarction and received intravenous thrombolysis with rt-PA and were admitted in Department of Neurology of the First Hospital of China Medical University from July 2017 to October 2018.Using retrospective case-control study,we divided 143 patients into group of 100 cases(69.9%)with good outcome and group of 43 cases(30.1%)with poor outcome then compared their general data with univariate and multivariate analysis to explore whether TOAST classification affected the long-term outcome of intravenous thrombolysis with rt-PA in acute cerebral infarction.According to TOAST classification,143 patients were divided into 99 cases of large artery atherosclerosis subtype(69.2%),21 cases of cardiogenic embolism subtype(14.7%),16 cases of small artery occlusion subtype(11.2%),7 cases of other determined etiology and undetermined etiology subtype(4.9%).Then we further discussed the related factors affecting long-term outcome of different TOAST subtypes in patients with acute cerebral infarction.Results: Univariate analysis showed that there was statistically significant difference in age,TOAST classification,ONT,IPAQ score,SSS score,TG between the two groups with different outcomes(P<0.05).Multivariate logistic regression analysis suggested that age(OR=1.055,95%CI 1.002-1.111,P<0.05),SSS score(OR=1.159,95%CI 1.090-1.232,P<0.05)were independent risk factors affecting the long-term outcome of intravenous thrombolysis with rt-PA in acute cerebral infarction.For large artery atherosclerosis subtype,univariate analysis showed that there was statistically significant difference in age,IPAQ score,ONT,SSS score between the good outcome group and poor outcome group(P<0.05).Multivariate logistic regression analysis revealed,age(OR=1.072,95%CI 1.002-1.148,P<0.05),SSS score(OR=1.157,95%CI 1.080-1.238,P<0.05)were independent risk factors affecting the long-term outcome of large artery atherosclerosis subtype while IPAQ score(moderate level)(P<0.05,OR=0.128,95%CI 0.025-0.641)was independent protective factor.Univariate analysis indicated that IPAQ score showed statistically significant difference between the two groups with different outcomes for cardiogenic embolism subtype(P<0.05),while multivariate logistic regression analysis showed no statistically significant difference between the two groups(P>0.05).Conclusion: TOAST classification affects the long-term outcome of intravenous thrombolysis with rt-PA in acute cerebral infarction although it is not an independent factor.Age and severity of stroke are independent risk factors affecting the long-term outcome of intravenous thrombolysis with rt-PA in acute cerebral infarction.Age and severity of stroke are independent risk factors affecting the long-term outcome of intravenous thrombolysis with rt-PA in large artery atherosclerosis subtype of acute cerebral infarction while prestroke physical activity in moderate level is an independent protective factor.