Merkler Alexander E, Salehi Omran Setareh, Gialdini Gino, Lerario Michael P, Yaghi Shadi, Elkind Mitchell S V, Navi Babak B
From the Department of Neurology (A.E.M., S.S.O., M.P.L., B.B.N.) and Brain and Mind Research Institute (A.E.M., S.S.O., G.G., M.P.L., B.B.N.), Weill Cornell Medicine, New York, NY; Department of Neurology, NewYork-Presbyterian Queens, Flushing (M.P.L.); Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI (S.Y.); Department of Neurology, Columbia University School of Medicine, New York, NY (M.S.V.E.); and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.).
Stroke. 2017 Aug;48(8):2282-2284. doi: 10.1161/STROKEAHA.117.018119. Epub 2017 Jul 5.
It is uncertain whether previous ischemic stroke within 3 months of receiving intravenous thrombolysis (tPA [tissue-type plasminogen activator]) for acute ischemic stroke (AIS) is associated with an increased risk of adverse outcomes.
Using administrative claims data, we identified adults with AIS who received intravenous tPA at California, New York, and Florida hospitals from 2005 to 2013. Our primary outcome was intracerebral hemorrhage, and our secondary outcomes were unfavorable discharge disposition and inpatient mortality. We used logistic regression to compare rates of outcomes in patients with and without previous ischemic stroke within 3 months of intravenous tPA for AIS.
We identified 36 599 AIS patients treated with intravenous tPA, of whom 568 (1.6%) had a previous ischemic stroke in the past 3 months. Of all patients who received intravenous tPA, the rate of intracerebral hemorrhage was 4.9% (95% confidence interval [CI], 4.7%-5.1%), and death occurred in 10.7% (95% CI, 10.4%-11.0%). After adjusting for demographics, vascular risk factors, and the Elixhauser Comorbidity Index, previous ischemic stroke within 3 months of thrombolysis for AIS was not associated with an increased risk of intracerebral hemorrhage (odds ratio, 0.9; 95% CI, 0.6-1.4; =0.62), but was associated with an increased risk of death (odds ratio, 1.5; 95% CI, 1.2-1.9; =0.001) and unfavorable discharge disposition (odds ratio, 1.3; 95% CI, 1.0-1.7; =0.04).
Among patients who receive intravenous tPA for AIS, recent ischemic stroke is not associated with an increased risk of intracerebral hemorrhage but is associated with a higher risk of death and unfavorable discharge disposition.
对于急性缺血性卒中（AIS）患者，在接受静脉溶栓治疗（组织型纤溶酶原激活剂[tPA]）3个月内发生过缺血性卒中，是否会增加不良结局的风险尚不确定。
利用行政索赔数据，我们确定了2005年至2013年期间在加利福尼亚州、纽约州和佛罗里达州医院接受静脉tPA治疗的AIS成年患者。我们的主要结局是脑出血，次要结局是不良出院处置和住院死亡率。我们使用逻辑回归比较在AIS静脉tPA治疗3个月内有或无既往缺血性卒中患者的结局发生率。
我们确定了36599例接受静脉tPA治疗的AIS患者，其中568例（1.6%）在过去3个月内有过缺血性卒中。在所有接受静脉tPA治疗的患者中，脑出血发生率为4.9%（95%置信区间[CI]，4.7%-5.1%），死亡率为10.7%（95%CI，10.4%-11.0%）。在调整了人口统计学、血管危险因素和埃利克斯豪泽合并症指数后，AIS溶栓治疗3个月内的既往缺血性卒中与脑出血风险增加无关（比值比，0.9；95%CI，0.6-1.4；P=0.62），但与死亡风险增加（比值比，1.5；95%CI，1.2-1.9；P=0.001）和不良出院处置（比值比，1.3；95%CI，1.0-1.7；P=0.04）有关。
在接受静脉tPA治疗的AIS患者中，近期缺血性卒中与脑出血风险增加无关，但与死亡风险和不良出院处置风险较高有关。
