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Fischer U, Mono ML, Zwahlen M, Nedeltchev K, Arnold M, Galimanis A, Bucher S, Findling O, Meier N, Brekenfeld C, Gralla J, Heller R, Tschannen B, Schaad H, Waldegg G, Zehnder T, Ronsdorf A, Oswald P, Brunner G, Schroth G, Mattle HP. Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population. Stroke 2012; 43:1039-45. [DOI: 10.1161/strokeaha.111.630384] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Thrombolysis improves outcome of patients with acute ischemic stroke, but it is unknown whether thrombolysis has a measurable effect on long-term outcome in a defined population.
Methods—
We prospectively assessed demographic data, management, and outcome of acute ischemic stroke patients admitted within 48 hours to 18 primary care hospitals of the canton of Bern (969 299 inhabitants) during 12 months. Blinded follow-up was obtained at 3 and 12 months. Predictors of mortality and favorable outcome (modified Rankin Scale score ≤2) at 3 and 12 months using logistic regression were analyzed.
Results—
From December 2007 to December 2008, 807 patients (mean age, 72 years) were included. Median National Institutes of Health Stroke Scale score on admission was 5; 107 patients (13%) received intravenous, intra-arterial, or mechanical thrombolysis. Estimated cumulative mortality at 3 months was 20.6% and at 12 months 27.4%. Age 75 years or older, higher National Institutes of Health Stroke Scale scores, and higher Charlson comorbidity index were independent predictors of mortality at 3 and 12 months. Estimated favorable outcome at 3 months was 48.2% and at 12 months was 44.6%. Thrombolysis was the only modifiable independent predictor of favorable outcome at 3 (relative risk, 1.49; 95% CI, 1.18–1.89) and 12 months (relative risk, 1.59; 95% CI, 1.24–2.04), whereas age younger than 75 years, male gender, National Institutes of Health Stroke Scale score <4, and lower Charlson comorbidity index were nonmodifiable predictors.
Conclusions—
Thirteen percent of acute ischemic stroke patients admitted within 48 hours to Bernese hospitals underwent thrombolysis, which exerted a measurable effect on 3-month outcome in this population. This effect was sustained at 12 months. Age, stroke severity, Charlson comorbidity index, and male gender were independent nonmodifiable predictors of outcome.
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Affiliation(s)
- Urs Fischer
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marie-Luise Mono
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marcel Zwahlen
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Krassen Nedeltchev
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Marcel Arnold
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Aekatarini Galimanis
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Sabine Bucher
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Oliver Findling
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Niklaus Meier
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Caspar Brekenfeld
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Jan Gralla
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Regula Heller
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Beatrice Tschannen
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Heinz Schaad
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Gabriel Waldegg
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Thomas Zehnder
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Anke Ronsdorf
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Phillip Oswald
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Georg Brunner
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Gerhard Schroth
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
| | - Heinrich P. Mattle
- From the Department of Neurology (U.F., M.M., K.N., M.A., A.G., O.F., N.M., H.P.M.), University Hospital Bern and University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine (M.Z., S.B.), University of Bern, Bern, Switzerland; Clinical Trials Unit of the Inselspital and the Faculty of Medicine (C.B., J.G., G.S.), University of Bern, Bern, Switzerland; Institute of Neuroradiology (C.B., J.G., G.S.), University Hospital Bern and University of Bern, Bern, Switzerland; Verein
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