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Acta Neurol Scand. 2018 Mar;137(3):347-355. doi: 10.1111/ane.12880. Epub 2017 Dec 8.

Clinical outcome of cardioembolic stroke treated by intravenous thrombolysis.

Author information

1
Department of Neurology, Ostrava Vitkovice Hospital, Agel Research and Training Institute, Ostrava, Czech Republic.
2
Department of Neurology and Neurosurgery, Republican Vilnius University Hospital, Vilnius University, Vilnius, Lithuania.
3
Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania.
4
2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
5
Department of Neurology, L. Pasteur University Hospital in Kosice, Safarik University, Kosice, Slovakia.
6
Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
7
Department of Neurology, Democritus University of Thracr, Athens, Greece.
8
Department of Neurology, International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic.

Abstract

INTRODUCTION:

Cardioembolic stroke (CS) in patients without thrombolytic treatment is associated with a worse clinical outcome and higher mortality compared to other types of stroke. The aim of this study was to determine the clinical outcome of CS in patients treated by intravenous thrombolysis (IVT).

MATERIAL AND METHODOLOGY:

Data of patients from the SITS-EAST register (Safe Implementation of Treatments in Stroke) were analyzed in patients who received IVT treatment from 2000 to April 2014. The effect of the stroke etiology according to ICD-10 classification on outcome was analyzed using a univariate and multivariate analysis. The outcomes were assessed as follows: excellent clinical outcome (modified Rankin scale (mRS) 0-1) at 3 months, the rate of symptomatic intracranial hemorrhage (sICH), mortality, and improvement at 24 hours after IVT.

RESULTS:

Data of 13 772 patients were analyzed. CS represented 30% of all strokes. The mean age of patients with CS, atherothrombotic stroke, lacunar stroke, and other stroke was 70.8, 66.7, 66.2, and 63.3 years, respectively (P < .001). Severity of stroke on admission by median NIHSS score was 13 points in patients with CS, 12 points - in atherothrombotic stroke, 7 points - in lacunar stroke, and 10 points-in other stroke types (P < .001). No difference in mortality was detected among atherothrombotic and CS; however, atherothrombotic strokes had higher odds of sICH [OR = 1.63 (95% CI: 1.07-2.47), P = .023], lower odds of early improvement [OR = 0.79 (95% CI: 0.72-0.86), P < .001], and excellent clinical outcome [OR = 0.77 (95% CI: 0.67-0.87), P < .001] compared with CS.

CONCLUSIONS:

Cardioembolic strokes are not associated with increased mortality. Patients with CS are less likely to have sICH and have better outcome after IVT.

KEYWORDS:

SITS register; cardioembolic stroke; outcome; thrombolysis

PMID:
29218699
DOI:
10.1111/ane.12880
[Indexed for MEDLINE]

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