Effects of intravenous rtPA in patients with minor stroke

Figures & data

Figure 1. Flowchart of included patients.

Table 1. Baseline characteristic and outcomes in patient cohort of PS-matching.

Characteristics	Patients without IV rtPA treatment (n = 1163)	Patients with IV rtPA treatment (n = 1163)	P	SMD
Age, year, mean (SD)	59.1 (13.8)	59.1 (12.7)	.995^d	<0.001
Male, n (%)	856 (73.6)	852 (73.3)	.888^a	0.008
Myocardial infarction, n (%)	20 (1.70)	23 (1.98)	.758^a	0.019
History of AIS, n (%)	179 (15.4)	180 (15.5)	1.000^a	0.002
Baseline NIHSS, median (IQR)	2 (1, 4)	2 (1, 3)	.836^a	0.012
0–1, n (%)	369 (31.7)	346 (29.8)
2–3, n (%)	499 (42.9)	570 (49.0)
4–5, n (%)	295 (25.4)	247 (21.2)
Alcohol consumption, n (%)	192 (16.6)	216 (18.6)	.172^a	0.060
Smoking, n (%)	411 (35.3)	403 (34.7)	.832^a	0.011
Baseline SBP, mmHg, mean (SD)	150 (23.9)	150 (21.9)	.424^d	0.033
Baseline DBP, mmHg, mean (SD)	89.7 (15.2)	89.2 (14.8)	.448^d	0.032
Premorbid mRS =1 (n, %)	361 (31.0)	345 (29.7)	.499*	0.030
TOAST			.002^a	0.175
LAA, n (%)	517 (44.5)	461 (39.6)
SVD, n (%)	429 (36.9)	458 (39.4)
CE, n (%)	64 (5.50)	53 (4.60)
ODE, n (%)	42 (3.60)	63 (5.42)
UDE, n (%)	45 (3.90)	75 (6.45)
HBP, n (%)	842 (72.4)	835 (71.8)	.781^a	0.013
DM, n (%)	302 (26.0)	310 (26.7)	.742^a	0.016
AF, n (%)	31 (2.70)	35 (3.00)	.708^a	0.021
sICH, n (%)	10 (0.86)	8 (0.69)	.813^a	0.020
Hospital stays, median (IQR), days	8.26 (5.84, 11.7)	7.98 (5.89, 11.0)	.661^c	0.023
Mortality, n (%)	1 (0.09)	2 (0.17)	1.000^b	0.024
Excellent outcome, n (%)	971 (83.5)	1010 (86.8)	.027^a	0.094

^a Pearson’s χ² test.

^b Fisher’s exact test.

^c Mann–Whitney U test.

^d t-test.

PS: Propensity score; IV: intravenous; rtPA: recombinant tissue plasminogen activator antigen; SMD: standardized differences of the mean; AIS: acute ischemic stroke; NIHSS: National Institute of Health Stroke Scale; HbA1c: hemoglobin A1c; FBG: fasting blood glucose; HCY: homocysteine; SUA: serum uric acid; SBP: systolic blood pressure; DBP: diastolic blood pressure; mRS: modified Rankin Scale; TOAST: Trial of ORG 10172 in Acute Stroke Treatment; LAA: large artery atherosclerosis; SVD: small vessel disease; CE: cardio-embolism; ODE: other determined etiology; UDE: undetermined etiology; HBP: hypertension; DM: diabetes mellitus; AF: atrial fibrillation; sICH: symptomatic intracranial hemorrhage.

Figure 2. Distributions of mRS at 3 months of onset in the cohort of propensity score-matching.

Figure 3. Subgroup analyses of associations between IV-tPA treatment and functional outcome in the cohort of PS-matched + MI.

Table 2. Odd rates for excellent outcome according to IV rtPA treatment in patients with minor stroke.

	Adjusted OR (95% CI)	P
Cohort of PS-matching
Model 1	1.38 (1.09–1.75)	.009
Model 2	1.45 (1.12–1.87)	.004
Cohort without PS-matching
Model 3	1.32 (1.04–1.66)	.022
Model 4	1.29 (1.02–1.65)	.036
Cohort of PS-matching and MI
Model 5	1.30 (1.04–1.64)	.024
Model 6	1.38 (1.08–1.76)	.009

Model 1 was adjusted for TOAST factors. Model 2 was adjusted for baseline NIHSS, premorbid mRS, age, sex, history of HBP, DM, AF, smoking, alcohol drinking, and TOAST factors. Model 3 adjusted for baseline NIHSS score, premorbid mRS score, age, history of AIS, and TOAST factors. Model 4 was adjusted for baseline NIHSS, premorbid mRS, age, sex, history of AIS, HBP, DM, AF, smoking, alcohol drinking, and TOAST factors. Model 5 was adjusted for TOAST factors. Model 6 adjusted for baseline NIHSS score, premorbid mRS score, age, sex, history of HBP, DM, AF, smoking, alcohol drinking, and TOAST factors.

Abbreviations: OR, odds ratio; CI, confidence interval; IV, Intravenous; rtPA, recombinant tissue plasminogen activator antigen; PS, propensity score; MI, multiple imputation; TOAST, Trial of ORG 10172 in Acute Stroke Treatment; LAA, large artery atherosclerosis; mRS, modified Rankin Scale; HBP, hypertension; DM, diabetes mellitus; AF, atrial fibrillation; AIS, acute ischemic stroke.

Figure 4. Functional outcomes assessed by mRS among patients with MIS in each subgroup. (A) Functional outcomes among patients with an NIHSS of 0–1. (B) Functional outcomes among patients with an NIHSS of 2–3. (C) Functional outcomes among patients with an NIHSS of 4–5.

Table 3. Odd rates for excellent outcome according to IV rtPA treatment in each subgroup with different baseline NIHSS score.

Subgroup		Patients with IV rtPA treatment, n (%)	Unadjusted OR (95%CI)	P	Adjusted OR (95%CI)	P
Baseline NIHSS 0-1 group	Before PS matched	366, 27.5%	0.626 (0.392-0.999)	0.050	0.844 (0.482-1.476)^a	0.552
	After PS matched	344, 50.0%	0.851 (0.488-1.486)	0.571	0.816 (0.437-1.526)^b	0.525
Baseline NIHSS 2-3 group	Before PS matched	666, 52.7%	1.108 (0.810-1.515)	0.520	1.07 (0.772-1.494)^c	0.670
	After PS matched	486, 50.0%	1.29 (0.898-1.857)	0.168	1.22 (0.845-1.771)^d	0.287
Baseline NIHSS 4-5 group	Before PS matched	430, 57.9%	1.443 (1.032-2.017)	0.032	1.65 (1.145-2.370)^e	0.007
	After PS matched	241, 50.0%	1.48 (0.991-2.199)	0.056	1.53 (1.024-2.296)^f	0.038

^a Indicated adjustment for history of AIS, baseline NIHSS, baseline SBP, DM, and TOAST factors.

^b Indicated adjustment for TOAST factors.

^c Adjustment for history of AIS, baseline NIHSS, baseline SBP, HBP, and TOAST factors.

^d Adjusted for age, DM, and TOAST factors.

^e Adjusted for age, sex, history of AIS, baseline NIHSS, baseline DBP, and TOAST factors.

^f Indicated adjustment for baseline NIHSS and TOAST scores.

OR: odds ratio; CI: confidence interval; IV: Intravenous; rtPA: recombinant tissue plasminogen activator antigen; PS: propensity score; TOAST: Trial of ORG 10172 in Acute Stroke Treatment; LAA: large artery atherosclerosis; mRS: modified Rankin Scale; HBP: hypertension; DM: diabetes mellitus; AF: atrial fibrillation; AIS: acute ischemic stroke.

Data availability statement

The data analyzed in the current study are available from the corresponding author upon reasonable request.