Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up

Walter Muruet; Anthony Rudd; Charles D A Wolfe; Abdel Douiri

doi:10.1161/STROKEAHA.117.019889

Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up

Walter Muruet , Anthony Rudd, Charles D A Wolfe, Abdel Douiri

Research output: Contribution to journal › Article › peer-review

56 Citations (Scopus)

283 Downloads (Pure)

Abstract

Background and Purpose: IV thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery since clinical trials follow-up times are limited.Methods: Patients registered between Jan-2005 and Dec-2015 to the population-based South London Stroke Register of first-ever strokes. Propensity score was employed to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan-Meier estimates, Cox Proportional Hazards and Restricted Mean Survival Time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results: From 2,052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time: 5.45 years (IQR 4.56). Survival was higher in the treatment group (median: 5.72 years) compared to control group (4.98 years, stratified log-rank test <0.001). The Number Needed to Treat (NNT) to prevent 1 death at 5 years was 12, and 20 at 10 years. After cox regression analysis, thrombolysis reduced risk of mortality by 37% (HR 0.63, 95%CI 0.48-0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (HR 0.58 95%CI 0.40-0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived one year longer than controls. At 5 years, thrombolysis was associated with independence (BI ≥90, OR 3.76 95%CI 1.22-13.34) and increased odds of a higher FAI (proportional OR 2.37 95%CI 1.16-4.91). There was no difference in stroke recurrence.Conclusion: Thrombolysis with IV alteplase is associated with improved long-term survival and functional status after ischemic stroke.

Original language	English
Pages (from-to)	607-613
Journal	Stroke
Volume	49
Issue number	3
Early online date	12 Feb 2018
DOIs	https://doi.org/10.1161/STROKEAHA.117.019889
Publication status	Published - 31 Mar 2018

Keywords

Stroke
alteplase
thrombolysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1161/STROKEAHA.117.019889Licence: CC BY

Long-Term Survival After_GUTIERREZ_Firstonline12February2018_GOLD VoR (CC BY)Final published version, 1.28 MBLicence: CC BY

http://stroke.ahajournals.org/lookup/doi/10.1161/STROKEAHA.117.019889Licence: CC BY

Cite this

@article{d75f8e8a11454a7488cbed511855e69b,

title = "Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up",

abstract = "Background and Purpose: IV thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery since clinical trials follow-up times are limited.Methods: Patients registered between Jan-2005 and Dec-2015 to the population-based South London Stroke Register of first-ever strokes. Propensity score was employed to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan-Meier estimates, Cox Proportional Hazards and Restricted Mean Survival Time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results: From 2,052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time: 5.45 years (IQR 4.56). Survival was higher in the treatment group (median: 5.72 years) compared to control group (4.98 years, stratified log-rank test <0.001). The Number Needed to Treat (NNT) to prevent 1 death at 5 years was 12, and 20 at 10 years. After cox regression analysis, thrombolysis reduced risk of mortality by 37% (HR 0.63, 95%CI 0.48-0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (HR 0.58 95%CI 0.40-0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived one year longer than controls. At 5 years, thrombolysis was associated with independence (BI ≥90, OR 3.76 95%CI 1.22-13.34) and increased odds of a higher FAI (proportional OR 2.37 95%CI 1.16-4.91). There was no difference in stroke recurrence.Conclusion: Thrombolysis with IV alteplase is associated with improved long-term survival and functional status after ischemic stroke. ",

keywords = "Stroke, alteplase, thrombolysis",

author = "Walter Muruet and Anthony Rudd and Wolfe, {Charles D A} and Abdel Douiri",

year = "2018",

month = mar,

day = "31",

doi = "10.1161/STROKEAHA.117.019889",

language = "English",

volume = "49",

pages = "607--613",

journal = "Stroke",

issn = "0039-2499",

publisher = "American Heart Association",

number = "3",

}

TY - JOUR

T1 - Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke

T2 - A Propensity Score-Matched Cohort With up to 10-Year Follow-Up

AU - Muruet , Walter

AU - Rudd, Anthony

AU - Wolfe, Charles D A

AU - Douiri, Abdel

PY - 2018/3/31

Y1 - 2018/3/31

N2 - Background and Purpose: IV thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery since clinical trials follow-up times are limited.Methods: Patients registered between Jan-2005 and Dec-2015 to the population-based South London Stroke Register of first-ever strokes. Propensity score was employed to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan-Meier estimates, Cox Proportional Hazards and Restricted Mean Survival Time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results: From 2,052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time: 5.45 years (IQR 4.56). Survival was higher in the treatment group (median: 5.72 years) compared to control group (4.98 years, stratified log-rank test <0.001). The Number Needed to Treat (NNT) to prevent 1 death at 5 years was 12, and 20 at 10 years. After cox regression analysis, thrombolysis reduced risk of mortality by 37% (HR 0.63, 95%CI 0.48-0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (HR 0.58 95%CI 0.40-0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived one year longer than controls. At 5 years, thrombolysis was associated with independence (BI ≥90, OR 3.76 95%CI 1.22-13.34) and increased odds of a higher FAI (proportional OR 2.37 95%CI 1.16-4.91). There was no difference in stroke recurrence.Conclusion: Thrombolysis with IV alteplase is associated with improved long-term survival and functional status after ischemic stroke.

AB - Background and Purpose: IV thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery since clinical trials follow-up times are limited.Methods: Patients registered between Jan-2005 and Dec-2015 to the population-based South London Stroke Register of first-ever strokes. Propensity score was employed to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan-Meier estimates, Cox Proportional Hazards and Restricted Mean Survival Time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results: From 2,052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time: 5.45 years (IQR 4.56). Survival was higher in the treatment group (median: 5.72 years) compared to control group (4.98 years, stratified log-rank test <0.001). The Number Needed to Treat (NNT) to prevent 1 death at 5 years was 12, and 20 at 10 years. After cox regression analysis, thrombolysis reduced risk of mortality by 37% (HR 0.63, 95%CI 0.48-0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (HR 0.58 95%CI 0.40-0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived one year longer than controls. At 5 years, thrombolysis was associated with independence (BI ≥90, OR 3.76 95%CI 1.22-13.34) and increased odds of a higher FAI (proportional OR 2.37 95%CI 1.16-4.91). There was no difference in stroke recurrence.Conclusion: Thrombolysis with IV alteplase is associated with improved long-term survival and functional status after ischemic stroke.

KW - Stroke

KW - alteplase

KW - thrombolysis

U2 - 10.1161/STROKEAHA.117.019889

DO - 10.1161/STROKEAHA.117.019889

M3 - Article

SN - 0039-2499

VL - 49

SP - 607

EP - 613

JO - Stroke

JF - Stroke

IS - 3

ER -

Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Cite this