NDLI: Predicting clinical outcomes after thrombolysis using the iScore: results from the Virtual International Stroke Trials Archive.

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Predicting clinical outcomes after thrombolysis using the iScore: results from the Virtual International Stroke Trials Archive.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Reeves, Mathew J. Saposnik, Gustavo Ovbiagele, Bruce Johnston, S. Claiborne Bath, Philip M. W.
Organization	VISTA Collaboration
Description	Author Affiliation: Saposnik G ( From the Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, Institute of Health Policy, Management and Evaluation (iHPME), University of Toronto, Toronto, Canada (G.S.))
Abstract	BACKGROUND AND PURPOSE: The ischemic stroke risk score (iScore) is a validated tool developed to estimate the risk of death and functional outcomes early after an acute ischemic stroke. Our goal was to determine the ability of the iScore to estimate clinical outcomes after intravenous thrombolysis tissue-type plasminogen activator (tPA) in the Virtual International Stroke Trials Archive (VISTA). METHODS: We applied the iScore (www.sorcan.ca/iscore) to patients with an acute ischemic stroke within the VISTA collaboration to examine the effect of tPA. We explored the association between the iScore (<200 and ≥200) and the primary outcome of favorable outcome at 3 months defined as a modified Rankin scale score of 0 to 2. Secondary outcomes included death at 3 months, catastrophic outcomes (modified Rankin scale, 4-6), and Barthel index >90 at 3 months. RESULTS: Among 7140 patients with an acute ischemic stroke, 2732 (38.5%) received tPA and 711 (10%) had an iScore ≥200. Overall, tPA treatment was associated with a significant improvement in the primary outcome among patients with an iScore <200 (38.9% non-tPA versus 47.5% tPA; P<0.001) but was not associated with a favorable outcome among patients with an iScore ≥200 (5.5% non-tPA versus 7.6% tPA; P=0.45). In the multivariable analysis after adjusting for age, baseline National Institutes of Health Stroke Scale, and onset-to-treatment time, there was a significant interaction between tPA administration and iScore; tPA administration was associated with 47% higher odds of a favorable outcome at 3 months among patients with an iScore <200 (odds ratio, 1.47; 95% confidence interval, 1.30-1.67), whereas the association between tPA and favorable outcome among those with an iScore ≥200 remained nonsignificant (odds ratio, 0.80; 95% confidence interval, 0.45-1.42). A similar pattern of benefit with tPA among patients with an iScore <200, but not ≥200, was observed for secondary outcomes including death. CONCLUSIONS: The iScore is a useful and validated tool that helps clinicians estimate stroke outcomes. In stroke patients participating in VISTA, an iScore <200 was associated with better outcomes at 3 months after tPA.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	10
Volume Number	44
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2013-10-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Brain Ischemia Drug Therapy Databases, Factual Fibrinolytic Agents Therapeutic Use Models, Biological Stroke Thrombolytic Therapy Tissue Plasminogen Activator Mortality Clinical Trials As Topic Predictive Value Of Tests Risk Factors Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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