Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Department of Neurology, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.
Ann Med. 2024 Dec;56(1):2304653. doi: 10.1080/07853890.2024.2304653. Epub 2024 Jan 30.
Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores.
Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score.
Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, 1.000) and sICH (0.69% vs. 0.86%, 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, = 0.525) and1.22 (95% CI 0.845-1.77, = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, = 0.038).
IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.
轻度缺血性卒中（MIS）患者是否能从静脉溶栓（IVT）中获益仍存在争议。IVT 疗效与基线国立卫生研究院卒中量表（NIHSS）评分之间的关系在 MIS 中尚不清楚，而在中度和重度卒中中的关系则是已知的。本研究旨在探讨 IVT 在 MIS 患者中的效果，并分析其在不同基线 NIHSS 评分患者中的疗效。
在 32 个中心筛选出发病 4.5 小时内 NIHSS 评分≤5 的患者。采用倾向评分匹配，将接受 IVT 治疗的患者与未接受 IVT 治疗的患者按 1:1 比例匹配。发病 3 个月后改良 Rankin 量表（mRS）评分≤1 定义为良好结局。安全性结局包括死亡率和症状性颅内出血（sICH）。采用多变量分析计算良好结局的调整优势比（OR）。根据基线 NIHSS 评分进一步分析 IVT 的效果。
在筛选出的 23853 例患者中，纳入了 3336 例发病 4.5 小时内到达医院的 MIS 患者。接受 IVT 治疗的 1163 例患者与未接受 IVT 治疗的 1163 例患者相匹配。在轻度卒中患者中，IVT 的调整 OR 为 1.38（95%CI：1.09-1.75，P=0.009），良好结局的发生率更高。接受 IVT 治疗和未接受 IVT 治疗的患者死亡率（0.17%比 0.09%，P=1.000）和 sICH（0.69%比 0.86%，P=0.813）无显著差异。亚组分析显示，在基线 NIHSS 0-1 或 2-3 分亚组中，IVT 无显著效果，调整 OR 分别为 0.816（95%CI 0.437-1.53，P=0.525）和 1.22（95%CI 0.845-1.77，P=0.287）。在 NIHSS 评分 4-5 分的患者中，IVT 效果显著，调整 OR 为 1.53（95%CI 1.02-2.30，P=0.038）。
IVT 可改善 MIS 结局。sICH 和死亡率风险并未增加，特别是 NIHSS 评分 4-5 分的患者，可显著获益于 IVT。
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