Cerebral Thrombolysis in Rural Residents Aged ≥ 80

Figures & data

Table 1 The Clinical Characteristics of the Subgroups of Stroke Patients Treated with iv-Thrombolysis Aged ≥80 Living in Rural and Urban Areas

Variables	Patients Living in Rural Areas	Patients Living in Urban Areas	p Value
n (%) 231	147(63,64)	84 (36,36)	—
Demographic data
Male gender, n (%)	44 (29,93)	16 (19,05)	0.069
Baseline mRS 0–2 Arterial hypertension	135 (91.84) 97 (65.99)	74(88.10) 68 (90.95)	0.351 0.015
Coronary heart disease	77 (52.38)	38 (45.24)	0.296
History of heart infarct	11 (7.48)	14 (16.67)	0.030
Atrial fibrillation	86 (58.50)	38 (45.24)	0.051
Diabetes mellitus	38 (25.85)	19 (22.62)	0.583
Renal insufficiency	48 (35.04)	37 (48.68)	0.051
Dyslipidemia	111 (75.510	55 (65.48)	0.103
Smoking	4 (2.72	1 (1.19)	0.441
Prior stroke	17 (11.56)	13 (15.48)	0.394
Prior TIA	12 (8.16)	0	0.007
Antiplatelet therapy before stroke	92 (62.59)	51 (60.71)	0.778
Anticoagulant therapy before stroke	25 (17.01)	8 (9.52)	0.118
Logistic parameters
Onset to treatment time [min] median (IQR)	156 (134.00–205.00)	160.00 (120.00–182.00)	0.210
Onset to door time [min] median (IQR)	90.00 (60.00–120.00)	90.00 (50.00–114.50)	0.378
Door to treatment time [min] (IQR)	60.00 (45.00–88.00)	65.50 (40.00–99.00)	0.555
Stroke onset time
Nighttime (20:01–06:59h)	18(13.64)	16(21.62)	0.138
Working days	87(65.91)	46(62.16)	0.590
NIHSS on admission [points] median (IQR)	13.00(9.00–18.00)	12.00(8.80–16.00)	0.066
Arterial blood pressure on admission [mmHg] median (IQR)
MAP	103.33 (96.00–114.00)	115.00 (100.00–121.00)	0.036
Systolic	80.00 (80.00–95.00)	90.00 (80.00–100.00)	0.056
Diastolic	160.00 (140.00–170.00)	165.00 (150.00–176.00)	0.137
Radiological findings in CT or MR scans at baseline, n (%)
Early ischemic changes	43 (29.25)	25 (29.76)	0.934
Old ischemic changes	67 (45.58)	30 (35.71)	0.144
Laboratory findings before thrombolysis median (IQR)
Glucose level [mmol/L]	6.68 (5.70–8.80)	6.90 (5.75–8.22)	0.886
Cholesterol level [mmol/L]	4.82 (4.09–5.88)	4.55 (3.90–5.66)	0.200
Hemoglobin level [g/dL]	13.60 (12.70–14.40)	13.10 (11.90–14.10)	0.047
White blood cells [x10^9/L]	7.70 (6.40–9.20)	8.25 (6.90–9.30)	0.149
Creatinine level [µmol/L]	84.00 (71.50–97.00)	88.40 (70.50–111.00)	0.063
Glomerular filtration rate [mL/min/1.73 m^2]°	64.00 (52.00–79.00)	58.00 (41.50–75.00)	0.037
aPTT median (IQR)	27.30 (24.70–30.10)	27.20 (24.75–29.90)	0.833
INR median (IQR)	1.07 (1.00–1.10)	1.03 (1.00–1.10)	0.468
Radiological findings in control CT scans, n (%)
No ischemia	60 (40.82)	22 (26.19)	0.025
Ischemic changes	105 (71.43)	66 (78.57)	0.234
COED	39 (26.53)	29 (34.52)	0.200
Hemorrhagic Transformationǂ	22 (16.06)	21 (27.63)	0.044
Etiological classification, n (%)
Large vessel disease	87 (59.18)	46 (54.76)	0.513
Cardioembolism	30 (20.41)	19 (22.62)	0.692
Lacunar stroke	11 (7.48)	13 (15.48)	0.055
Undetermined etiology	19 (12.93)	6 (7.14)	0.173
mRS 0–2 at three months, n(%)	50 (34.01)	37 (44.05)	0.130
SICH ǂ,n	8 (5.44)	12 (14.29)	0.021
3-month mortality, n (%)	42 (28.57)	26 (30.95)	0.702

Notes: ^⁰According to the MDRD formula; ^ǂaccording to the ECASS II criteria. The bold values show the significance of the p < 0.05.

Abbreviations: TIA, transient ischemic attack; mRS, modified Rankin Scale; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; aPTT, activated partial thromboplastin time; INR, international normalized ratio; CT, computed tomography; MCA, middle cerebral artery; COED, cerebral edema; ECASS, European Cooperative Acute Stroke Study; SICH, symptomatic intracerebral hemorrhage; MDRD, Modification Diet for Renal Disease; SD, standard deviation; IQR, interquartile range (Q₁–Q₃).

Table 2 The Clinical Characteristics of the Subgroups of Stroke Patients Treated with iv-Thrombolysis Aged <80 and ≥80 Living in Rural Regions

Variables	Patients Aged <80	Patients Aged ≥80	p Value
n (%) 527	380 (72.10)	147 (27.90)	—
Demographic data
Male gender, n (%)	230 (60.53)	44 (29.93)	<0.001
Baseline mRS 0–2 Arterial hypertension	364 (95.79) 273 (71.84)	135 (91.84) 97 (65.99)	0.070 0.187
Coronary heart disease	177 (46.58)	77 (52.38)	0.232
History of heart infarct	49 (12,89)	11 (7.48)	0.079
Atrial fibrillation	122 (32.11)	86 (58.50)	<0.001
Diabetes mellitus	70 (18.42)	38 (25.85)	0.058
Renal insufficiency	59 (18.44)	48 (35.04)	<0.001
Dyslipidemia	308 (81.05)	111 (75.51)	0.157
Smoking	84 (22.11)	4 (2.72)	<0.001
Prior stroke	80 (21.05)	17 (11.56)	0.012
Prior TIA	66 (17.37)	12 (8.16)	0.007
Antiplatelet therapy before stroke	225 (59.21)	92 (62.59)	0.478
Anticoagulant therapy before stroke	35 (9.21)	25 (17.01)	0.011
Logistic parameters
Onset to treatment time [min] median (IQR)	165.00 (135.00–190.00)	156.00 (134.00–205.00)	0.510
Onset to door time [min] median (IQR)	105.00 (67.50–130.00)	90.00 (60.00–120.00)	0.054
Door to treatment time [min] (IQR)	60.00 (43.50–80.00)	60.00 (45.00–88.00)	0.152
Stroke onset time
Nighttime (20:01–06:59h)	66 (22.07)	18 (13.64)	0.041
Working days	213 (71.24)	87 (65.91)	0.268
NIHSS on admission [points] median (IQR)	12.00 (7.00–17.00)	13.00 (9.00–18.00)	<0.001
Arterial blood pressure on admission [mmHg] median (IQR)
MAP	110.00 (100.00–119.33)	103.33 (96.00–114.00)	0.028
Systolic	150.00 (140.00–170.00)	160.00 (140.00–170.00)	0.347
Diastolic	88.00 (80.00–91.00)	80.00 (80.00–95.00)	0.091
Radiological findings in CT or MR scans at baseline, n (%)
Early ischemic changes	135 (35.53)	43 (29.25)	0.172
Old ischemic changes	132 (34.74)	67 (45.58)	0.021
Laboratory findings before thrombolysis median (IQR)
Glucose level [mmol/L]	6.51 (5.79–7.90)	6.68 (5.70–8.80)	0.427
Cholesterol level [mmol/L]	5.13 (4.21–5.70)	4.82 (4.09–5.88)	0.268
Hemoglobin level [g/dL]	13.80 (12.70–14.80)	13.60 (12.70–14.40)	0.067
White blood cells [x10^9/L]	7.90 (6.90–9.60)	7.70 (6.40–9.20)	0.094
Creatinine level [µmol/L]	83.00 (69.80–91.20)	84.00(71.50–97.00)	0.309
Glomerular filtration rate [mL/min/1.73 m^2]°	74.00 (54.00–90.50)	64.00 (52.00–79.00)	0.010
aPTT median (IQR)	26.60 (24.80–28.80)	27.30 (24.70–30.10)	0.089
INR median (IQR)	1.02 (1.00–1.12)	1.07 (1.00–1.10)	0.282
Radiological findings in control CT scans, n (%)
No ischemia	109 (26.68)	60 (40.82)	0.007
Ischemic changes	286 (75.26)	105 (71.43)	0.367
COED	172 (45.26)	39 (26.53)	<0.001
Hemorrhagic transformationǂ	42 (13.13)	22 (16.06)	0.407
Etiological classification, n(%)
Large vessel disease	207 (54.47)	87 (59.18)	0.329
Cardioembolism	8 0(21.05)	30 (20.41)	0.870
Lacunar stroke	56 (14.74)	11 (7.48)	0.024
Undetermined etiology	37 (9.74)	19 (12.93)	0.286
mRS 0–2 at three months, n (%)	192 (50.53)	50 (34.01)	<0.001
SICH ǂ, n	31 (8.16)	8(5.44)	0.285
3-month mortality, n (%)	48 (12.63)	4 2(28.57)	<0.001

Notes: ^⁰According to the MDRD formula; ^ǂaccording to the ECASS II criteria. The bold values show the significance of the p < 0.05.

Abbreviations: TIA, transient ischemic attack; mRS, modified Rankin Scale; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; aPTT, activated partial thromboplastin time; INR, the international normalized ratio; CT, computed tomography; MCA, middle cerebral artery; COED, cerebral edema; ECASS, European Cooperative Acute Stroke Study; SICH, symptomatic intracerebral hemorrhage; MDRD, Modification Diet for Renal Disease; SD, standard deviation; IQR, interquartile range (Q₁-Q₃).

Table 3 Univariate Analysis Shoving Factors Associated with Unfavorable Outcome (mRS 3–5), 3-Month Mortality and SICH in Patients Living in Rural Areas

Variables	mRS 0–2	mRS 3–5	p Value	Survivors	Patients Who Died	p Value	Without SICH	With ICH	p Value
n (%) 527	332 (63.00)	195 (37.00)	—	437 (82.92)	90 (17.08)	—	488 (92.60)	39 7.40)	—
Demographic data
Male gender, n (%)	167 (50.30)	107 (54.87)	0.310	235 (53.78)	39 (43.33)	0.070	253 (51.84)	21 (53.85)	0.810
Octogenarian (80–89)	75 (22.59)	50 (25.64)	0.427	97 (22.20)	28 (31.11)	0.070	121 (24.80)	4 (10.26)	0.040
Nonagenarian (>89)	17 (5.12)	5 (2.56)	0.157	8 (1.83)	14 (15.56)	<0.001	18 (3.69)	4 (10.26)	0.048
Risk factors, n (%)
Baseline mRS 0–2	320 (96.39)	179 (91.79)	0.023	419 (9.88)	80 (88.89)	0.007	463 (94.88)	36 (92.31)	0.491
Arterial hypertension	243 (73.19)	127 (65.13)	0.051	310 (70.94)	60 (66.67)	0.420	34 5(70.70)	25 (64.10)	0.386
Coronary heart disease	161 (48.49)	93 (47.69)	0.859	210 (48.05)	44 (48.89)	0.885	238 (48.77)	16 (41.03)	0.352
History of heart infarct	38 (11.45)	22 (11.28)	0.954	48 (10.98)	12 (13.33)	0.522	54 (11.07)	6 (15.38)	0.414
Atrial fibrillation	118 (35.54)	90 (46.15)	0.016	165 (37.76)	43 (47.78)	0.076	192 (39.34)	16 (41.03)	0.836
Diabetes mellitus	70 (21.08)	38 (19.49)	0.661	86 (19.68)	22 (24.44)	0.307	102 (20.90)	6 (15.38)	0.411
Renal insufficiency	72 (23.76)	35 (22.73)	0.805	72 (19.62)	35 (38.89)	<0.001	9 9(22.86)	8(33.33)	0.238
Dyslipidemia	259 (78.01)	160 (82.05)	0.267	347 (79.41)	72 (80.00)	0.899	389 (79.71)	3 0(76.92)	0.678
Smoking	64 (19.28)	24 (12.31)	0.038	72 (16.48)	16 (17.78)	0.763	80 (16.39)	8(20,51)	0.507
Prior stroke	43 (12.95)	54 (27.69)	<0.001	86 (19.68)	11 (12.22)	0.096	91 (18.65)	(15.38)	0.613
Prior TIA	36 (10.84)	42 (21.54)	0.001	74 (1.93)	4 (4.44)	0.002	69 (14.14)	9 (23.08)	0.130
Antiplatelet therapy before stroke	193 (58.13)	124 (63.59)	0.217	262 (59.95)	55 (61.11)	0.838	287 (58.81)	30 (76.92)	0.026
Anticoagulant therapy before stroke	25 (7.53)	35 (17.95)	<0.001	48 (10.98)	12 (13.33)	0.522	52 (10.66)	8 (20.51)	0.062
Logistic parameters
Onset to treatment time [min] median (IQR)	165.00 (134.50–200.00)	165.00 (140.00–190.00)	0.761	165.00 (140.00–190.00)	150.00 (120.00–180.00)	0.018	164.00 (135.00–195.00)	175.00 (140.00–190.00)	0.385
Onset to door time [min] median (IQR)	90.0 (60.00–125.00)	100.00 (75.00–129.00)	0.112	100.00 (71.00–130.00)	75.00 (50.00–120.00)	<0.001	95.00 (65.00–121.50)	130.00 (70.00–130.00)	0.013
Door to treatment time [min] (IQR)	60.00 (43.50–85.00)	60.0 0(45.00–70.00)	0.087	60.00 (45.00–80.00)	60.00 (35.00–90.00)	0.595	60.00 (45.00–80.50)	60.00 (40.00–60.00)	0.228
Stroke onset time:
Daytime (07:00–20:00h)	235 (80.20)	112 (81.16)	0.815	276 (80.94)	71 (78.89)	0.662	330 (80.10)	1 7(89.47)	0.313
Nighttime (20:01–06:59h)	58 (19.80)	2 6(18.84)	0.815	65 (19.06)	19 (21.11)	0.662	82 (19.90)	2 (10.53)	0.313
Working days	203 (69.28)	97 (70.29)	0.832	236 (69.21)	64 (71.11)	0.727	286 (69.42)	14 (73.68)	0.692
NIHSS on admission [points] median (IQR)	11.00 (7.00–16.00)	14.00 (11.00–18.00)	<0.001	11.00 (7.00–16.00)	18.00 (12.00–20.00)	<0.001	12.00 (8.00–17.00)	14.00 (11.00–20.00	0.001
Arterial blood pressure on admission [mmHg] median (IQR)
MAP	106.67 (98.33–116.00)	110.00 (96.67–120.00)	0.127	106.67 (96.67–118.67)	107.33 (100.00–116.67)	0.941	106.67 (96.67–117.17)	116.00 (106.67–121.83)	0.051
Systolic	150.00 (136.00–170.00)	160.00 (140.00–170.00)	0.014	150.00 (140.00–170.00)	160.00 (140.00–170.00)	0.681	150.00 (140.00–170.00)	146.00 (140.00–170.00)	0.429
Diastolic	85.00 (80.00–93.00)	88.00 (80.00–93.00)	0.549	87.00 (80.00–95.00)	84.00 (80.00–90.00)	0.479	85.00 (80.00–93.00)	90.00 (80.00–95.00)	0.132
Baseline radiological findings in CT or MR scans, n (%)
Early ischemic changes	102 (30.72)	76 (38.97)	0.053	151 (35.55)	27 (30.00)	0.405	152 (31.15)	26 (66.67)	<0.001
Old ischemic changes	115 (34.64)	84 (43.08)	0.054	165 (37.76)	34 (37.78)	0.997	181 (37.09)	18 (46.15)	0.261
Laboratory findings before thrombolysis median (IQR)
Glucose level [mmol/L]	6.60 (5.62–8.30)	6.50 (5.80–7.70)	0.838	6.49 (5.70–7.90)	7.34 (6.00–8.90)	0.009	6.60 (5.70–8.26)	6.50 (5.80–7.20)	0.366
Cholesterol level [mmol/L]	5.03 (4.16–5.70)	5.24 (4.13–5.88)	0.645	5.12 (4.16–5.85)	4.75 (4.00–5.70)	0.136	5.03 (4.14–5.70)	5.80 (3.92–6.44)	0.019
Hemoglobin level [g/dL]	13.90 (12.90–14.90)	13.50 (12.60–14.20)	<0.001	13.80 (12.60–14.60)	13.85 (12.90–15.00)	0.296	13.80 (12.70–14.75)	13.20 (12.90–14.50)	0.406
White blood cells [x10^9/L]	7.90 (6.60–9.80)	7.70 (6.90–9.30)	0.516	7.70 (6.75–9.30)	8.80 (6.70–10.70)	0.011	7.70 (6.60–9.30)	9.40 (7.90–11.20)	<0.001
Creatinine level [µmol/L]	82.60 (69.00–95.00)	84.20 (71.00–91.00)	0.473	83.00 (69.80–91.00)	85.50 (71.00–107.00)	0.044	83.00 (69.80–92.55)	88.40 (83.00–91.20)	0.067
Glomerular filtration rate [mL/min/1.73 m^2]°	71.50 (56.00–89.50)	68.00 (41.00–86.00)	0.013	71.00 (52.00–89.00)	65.00 (54.00–86.00)	0.592	71.00 (55.00–89.00)	55.00 (10.00–78.00)	<0.001
aPTT median (IQR)	26.70 (24.60–29.00)	27.10 (25.00–29.10)	0.158	26.80 (24.80–29.20)	26.75 (24.55–28.80)	0.553	26.70 (24.70–29.20)	28.20 (26.60–28.80)	0.116
INR median (IQR)	1.02 (1.00–1.12)	1.04 (1.00–1.10)	0.361	1.02 (1.00–1.10)	1.09 (1.00–1.17)	0.045	1.02 (1.00–1.10)	1.14 (1.00–1.23)	<0.001
Radiological findings in controlCT scans,n (%)
No ischemia	123 (37.05)	46 (23.59)	0.001	162 (37.07)	7 (7.78)	<0.001	164 (33.61)	5 (12.82)	0.007
Ischemic changes	218 (65.66)	173 (88.72)	<0.001	316 (72.31)	75 (83.33)	0.029	352 (71.13)	39 (100.00)	<0.001
COED	108 (32.53)	103 (52.82)	<0.001	166 (37.99)	45 (50.00)	0.034	181 (37.09)	30 (76.92)	<0.001
Hemorrhagic transformationǂ	41 (13.53)	23 (14.94)	0.683	40 (10.90)	24 (26.67)	<0.001	45 (19.39)	19 (79.17)	<0.001
Etiological classification, n(%)
Large vessel disease	168 (50.60)	126 (64.62)	0.002	235 (53.78)	59 (65.56)	0.040	262 (53.69)	32 (82.05)	<0.001
Cardioembolism	67 (20.18)	43 (22.05)	0.610	90 (20.59)	20 (22.22)	0.729	104 (21.31)	6 (15.38)	0.381
Lacunar stroke	59 (17.77)	8 (4.10)	<0.005	65 (14.87)	2 (2.22)	0.001	67 (13.73)	0	0.013
Undetermined etiology	38 (11.45)	18 (9.23)	0.426	47 (10.76)	9 (10.00)	0.832	55 (11.27)	1 (2.56)	0.089
mRS 0–2 at three months, n(%)	—	—	—	—	—	—	214 (49.39)	1 (2.56)	<0.001
SICH ǂ, n(%)	18 (5.42)	21 (10.77)	0.023	22 (5.03)	17 (18.89)	<0,001	—	—	—
3-month mortality	—	—	—	—	—	—	73 (14.96)	17 (43.59)	<0.001

Notes: ^⁰According to the MDRD formula; ^ǂaccording to the ECASS II criteria. The bold values show the significance of the p < 0.05.

Abbreviations: TIA, transient ischemic attack; mRS, modified Rankin Scale; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; aPTT, activated partial thromboplastin time; INR, the international normalized ratio; CT, computed tomography; MCA, middle cerebral artery; COED, cerebral edema; ECASS, European Cooperative Acute Stroke Study; SICH, symptomatic intracerebral hemorrhage; MDRD, Modification Diet for Renal Disease; SD, standard deviation; IQR, interquartile range (Q₁–Q₃).

Figure 1 Multivariate logistic regression models showing factors associated with 90 days unfavorable outcome, 3-month mortality and SICH in patients treated with iv-thrombolysis living in rural areas.

Abbreviations: mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; COED, cerebral edema; SICH, symptomatic intracerebral hemorrhage; OR, odds ratio; CI, confidence interval.

Table 4 Univariate Analysis Shoving Factors Associated with Unfavorable Outcome (mRS 3–5), 3-Months Mortality and sICH in Patients Aged ≥80 Living in Rural Areas

Variables	mRS 0–2	mRS 3–5	p Value	Survivors	Patients Who Died	p Value	Without SICH	With SICH	p Value
n (%) 147	92 (62.58)	55 (37.42)	—	105 (71.43)	42 (28.57)	—	139 (94.56)	8 (5.44)	—
Demographic data
Male gender, n (%)	33 (35.87)	11 (20.00)	0.042	32 (30.48)	12 (28.57)	0.820	42 (30.22)	2 (25.00)	0.754
Risk factors, n (%)
Baseline mRS 0–2	86 (93,0.48)	49 (89.09)	0.347	99 (94.29)	36 (85.71)	0.086	129 (92.81)	6 (75.00)	0.074
Arterial hypertension	66 (71.74)	31 (56.36)	0.057	70 (66.67)	27 (64.29)	0.783	94 (67.63)	3 (37.50)	0.080
Coronary heart disease	48 (51.17)	29 (52.73)	0.948	54 (51.43)	23 (54.76)	0.715	74 (53.24)	3 (37.50)	0.386
History of heart infarct	8 (8.70)	3 (5.45)	0.470	6 (5.71)	5 (11.90)	0.198	11 (7.91)	0	0.408
Atrial fibrillation	50 (54.35)	36 (65.45)	0.186	60 (57.14)	26 (61.90)	0.596	81 (58.27)	5 (62.50)	0.813
Diabetes mellitus	19 (20.65)	19 (34.55)	0.063	25 (23.81)	13 (30.95)	0.371	35 (25.18)	3 (37.50)	0.438
Renal insufficiency	33 (36.67)	15 (31.91)	0.580	29 (30.53)	19 (45.24)	0.096	43 (33.33)	5 (62.50)	0.093
Dyslipidemia	70 (76.09)	41 (74.55)	0.833	78 (74.29)	33 (78.57)	0.585	104 (74.82)	(87.50)	0.417
Smoking	3 (3.26)	1 (1.82)	0.603	2 (1.90)	2 (4.76)	0.336	4 (2.88)	0	0.627
Prior stroke	10 (10.87)	7 (12.73)	0.733	15 (14.29)	2 (4.76)	0.103	17 (12.23)	0	0.293
Prior TIA	7 (7.61)	5 (9.09)	0.751	10 (9.52)	2 (4.76)	0.341	12 (8.63)	0	0.385
Antiplatelet therapy before stroke	52 (56.52)	40 (72.73)	0.049	66 (62.86)	26 (61.90)	0.914	87 (62.59)	5 (6250)	0.996
Anticoagulant therapy before stroke	9 (9.78)	16 (29.09)	0.002	20 (19.05)	5 (11.90)	0.298	24 (17.27)	1 (12.50)	0.727
Logistic parameters:
Onset to treatment time [min.] median (IQR)	162.50 (130.00–210.00)	155.00 (140.00–180.00	0.522	156.00 (135.00–200.00)	155.00 (120.00–210.00)	0.725	156.00 (135.00–205.00)	160.00 (102.50–175.00)	0.535
Onset to door time [min.] median (IQR)	86.50 (60.00–125.00)	90.00 (65.00–120.00)	0.844	90.00 (68.00–123.00)	77.50 (55.00–120.00)	0.219	90.00 (60.00–120.00)	59.50 (52.50–127.50)	0.374
Door to treatment time [min.] (IQR)	65.5 0(47.00–90.50)	50.00 (45.00–80.00)	0.043	60.00 (49.00–85.00)	75.00 (40.00–95.00)	0.323	60.00 (46.00–88.00)	53.00 (40.00–77.50)	0.567
Stroke onset time:
Daytime (07:00–20:00h)	78 (87.64)	36 (83.72)	0.538	77 (85.56)	37 (88.10	0.692	107 (86.29)	7 (87.50)	0.923
Nighttime (20:01–06:59h)	11 (12.36)	7 (16.28)	0.538	13 (14.44)	5 (11.90)	0.692	17 (13.71)	1 (12.50)	0923
Working days	55 (61.80)	32 (74.42)	0.152	57 (63.33)	30 (71.43)	0.361	81 (65.32)	6 (75.00)	0.576
NIHSS on admission [points] median (IQR)	13.00 (8.00–19.00)	15.00 (10.00–18.00)	0.595	12.00 (9.00–18.00)	18.50 (12.00–22.00)	<0.001	13.00 (9.00–18.00)	20.00 (13.50–21.00)	0.017
Arterial blood pressure on admission [mmHg] median (IQR)
MAP	105.00 (100.00–114.00)	96.00 (96.00–110.00)	0.048	100.00 (96.00–114.00)	106.67 (100.00–114.00)	0.674	101.67 (96.00–113.83)	108.00 (103.33–115.00)	0358
Systolic	160.00 (140.00–170.00)	160.00 (130.00–170.00)	0.983	160.00 (140.00–173.00)	152.00 (140.00–160.00)	0.222	160.00 (140.00–170.00)	146.00 (130.00–180.00)	0.773
Diastolic	84.00 (80.00–98.00)	80.00 (80.00–94.00)	0.634	80.00 (80.00–97.00)	86.50 (80.00–91.00)	0.566	80.00 (80.00–96.00)	89.00 (80.00–90.00)	0.963
Baseline radiological findings in CT or MR scans, n (%)
Early ischemic changes	20 (21.74)	23 (41.82)	0.010	35 (33.33)	8 (19.05)	0.085	41 (29.50)	2 (25.00)	0.786
Old ischemic changes	36 (39.13)	31 (56.36)	0.042	53 (50.48)	14 (33.33)	0.059	63 (45.52)	4 (50.00)	0.796
Laboratory findings before thrombolysis median (IQR)
Glucose level [mmol/L]	6.55 (5.61–8.35)	6.90 (5.85–11.10)	0.239	6.40 (5.70–8.70)	7.60 (6.00–8.93)	0.111	6.61 (5.70–8.80)	7.60 (6.20–9.05)	0.588
Cholesterol level [mmol/L]	4.71 (4.09–5.58)	5.07 (4.01–5.88)	0.300	4.82 (4.09–5.88)	4.83 (4.09–5.76)	0.847	4.82 (4.09–5.88)	5.23 (4.12–5.38)	0.824
Hemoglobin level [g/dL]	13.55 (12.90–14.50)	13.60 (12.40–14.10)	0.542	13.60 (12.70–14.20)	13.65 (12.70–14.90)	0.635	13.60 (12.60–14.40)	13.75 (12.95–14.65)	0758
White blood cells [x10^9/L]	7.60 (6.40–9.55)	7.9 0(6.90–8.70)	0.857	7.40 (6.40–8.70)	8.65 (6.50–11.00)	0.004	7.60 (6.40–9.10)	9.35 (7.65–11.20)	0050
Creatinine level [µmol/L]	83.65 (71.50–103.50)	84.20 (74.00–88.90)	0.336	83.30 (71.50–92.20)	89.00 (72.00–116.80)	0.073	83.70 (71.50–95.50)	107.55 (80.80–154.00)	0.052
Glomerular filtration rate [mL/min/1.73 m^2]°	65.00 (53.00–78.00)	64.00 (46.00–80.00)	0.531	65.00 (52.00–82.00)	62.00 (52.00–74.00)	0.259	65.00 (52.00–80.00)	56.50 (30.50–66.50)	0.165
aPTT median (IQR)	27.10 (24.70–29.55)	27.90 (24.80–32.40)	0.229	27.80 (24.80–31.70)	26.35 (24.60–28.80)	0.088	27.40 (24.70–31.00)	25.60 (24.65–28.05)	0.263
INR median (IQR)	1.05 (1.00–1.10)	1.07 (1.00–1.10)	0.861	1.07 (1.00–1.10)	1.09 (1.00–1.18)	0.252	1.07 (1.00–1.10	1.00 (0.91–1.14)	0.246
Radiological findings in control CT scans,n (%)
No ischemia	33 (35.87)	27 (49.09)	0.115	55 (52.38)	5 (11.90)	<0.001	60 (43.17)	0	0.016
Ischemic changes	58 (63.04)	47 (85.45)	0.004	72 (68.57)	33 (78.57)	0.225	97 (69.78)	8 (100.00)	0.065
COED	18 (19.57)	21 (38.18)	0.013	24 (22.86)	15 (35.71)	0.111	35 (25.18)	5 (50.00)	0.122
Hemorrhagic transformationǂ	15 (16.67)	7 (14.89)	0.788	12 (12.63)	10 (23.81)	0.100	–	–	–
Etiological classification, n (%)
Large vessel disease	58 (63.04)	29 (52.73)	0.218	57 (54.29)	30 (71.43)	0.056	82 (58.99)	5 (62.50)	0.844
Cardioembolism	17 (18.48)	13 (23.64)	0.453	21 (20.00)	9 (21.43)	0.846	28 (20.14)	2 (25.00)	0.740
Lacunar stroke	7 (7.61)	4 (7.27)	0.940	11 (10.48)	0	0.029	11 (7.91)	0	0.408
Undetermined etiology mRS 0–2 at three months, n (%)	10 (10.87) –	9 (16.36) –	0.337 –	16 (15.24) –	3 (7.14) –	0.186 –	18 (12.95) 50 (35.97)	1 (12.50) 0	0.970 0.037
SICH ǂ, n (%) 3-month mortality	7 (7.61)-	1 (1.82)-	0.134-	1 (0.95)-	7 (16.67)-	<0.001-	-37 (25.18)	-7 (87.50)	-<0.001

Notes: ^⁰According to the MDRD formula; ^ǂaccording to the ECASS II criteria. The bold values show the significance of the p < 0.05.

Abbreviations: TIA, transient ischemic attack; mRS, modified Rankin Scale; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; aPTT, activated partial thromboplastin time; INR, the international normalized ratio; CT, computed tomography; MCA, middle cerebral artery; COED, cerebral edema; ECASS, European Cooperative Acute Stroke Study; SICH, symptomatic intracerebral hemorrhage; MDRD, Modification Diet for Renal Disease; SD, standard deviation; IQR, interquartile range (Q₁–Q₃).

Figure 2 Multivariate logistic regression models showing factors associated with 90 days unfavorable outcome, 3-month mortality and SICH in patients aged ≥80 treated with iv-thrombolysis living in rural areas.

Abbreviations: mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; CT, computed tomography; COED, cerebral edema; sICH, symptomatic intracerebral hemorrhage; OR, odds ratio; CI, cConfidence interval.