The Oxfordshire Community Stroke Project classification system predicts clinical outcomes following intravenous thrombolysis: a prospective cohort study

Figures & data

Figure 1 Numbers of eligible patients.

Abbreviations: TIMS-China, Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China; rtPA, recombinant tissue plasminogen activator; OCSP, Oxfordshire Community Stroke Project; TACI, total anterior circulation infarct; PACI, partial anterior circulation infarct; POCI, posterior circulation infarct; LACI, lacunar infarct; h, hours.

Table 1 Characteristics of the study patients according to the Oxfordshire Community Stroke Project classification system

Variables	TACI (n=197)	PACI (n=700)	POCI (n=153)	LACI (n=65)	P-value
Mean age (years)	64.66±11.01	63.54±11.44	62.75±11.00	60.97±11.47	0.11
Male sex (n, %)	122 (61.93)	413 (59.00)	96 (62.75)	48 (73.85)	0.11
Past medical history
Independence (mRS 0–1) prior to stroke	185 (93.91)	672 (96.14)	146 (96.69)	65 (100.00)	0.16
Atrial fibrillation (n, %)	46 (23.35)	129 (18.43)	20 (13.07)	6 (9.23)	0.03
Hypertension (n, %)	107 (54.31)	412 (58.94)	99 (64.71)	41 (63.08)	0.15
Diabetes mellitus (n, %)	32 (16.24)	118 (16.86)	31 (20.26)	15 (23.08)	0.56
Hyperlipidemia (n, %)	16 (8.12)	46 (6.58)	8 (5.23)	3 (4.62)	0.81
Current smoking (n, %)	64 (32.49)	244 (34.86)	48 (31.37)	29 (44.62)	0.18
Previous smoking (n, %)	71 (36.04)	284 (40.57)	60 (39.22)	33 (50.77)	0.46
TIA history (n, %)	14 (7.11)	58 (8.29)	19 (12.42)	10 (15.38)	0.27
Stroke history (n, %)	41 (20.81)	123 (17.57)	32 (20.92)	8 (12.31)	0.56
Mean blood glucose (mmol/L)	8.01±3.31	7.49±2.85	8.25±3.07	7.94±3.39	0.01
Systolic blood pressure (mmHg)	146.48±21.93	148.21±20.74	148.27±21.17	150.26±19.40	0.60
Diastolic blood pressure (mmHg)	84.36±13.76	86.21±12.67	85.77±11.67	87.95±11.10	0.17
Receiving antiplatelet drugs within 24 h prior to thrombolysis (n, %)	34 (17.26)	96 (13.71)	18 (11.76)	7 (10.77)	0.40
Receiving anticoagulants within 24 h prior to thrombolysis (n, %)	3 (1.52)	11 (1.57)	3 (1.96)	1 (1.54)	0.99
Receiving antihypertensives within 24 h prior to thrombolysis (n, %)	71 (36.04)	271 (38.71)	57 (37.25)	30 (46.15)	0.53
INR prior to thrombolysis	1.02±0.14	1.02±0.12	1.01±0.12	1.03±0.42	0.71
Median NIHSS score (IQR)	16 (12–20)	10 (7–14)	10 (5–23)	7 (5–9)	,0.001
Median stroke onset to treatment time (IQR) (min)	169 (162–176)	169 (166–173)	167 (159–176)	162 (149–174)	0.65
Mean rtPA dose (mg)	55.45±10.40	56.53±10.71	57.97±12.55	57.98±11.47	0.13
Patients with standard dosage of rtPA (n, %)	130 (65.99)	502 (71.71)	99 (64.71)	43 (66.15)	0.19
Mean weight (kg)	65.46±11.90	65.98±11.40	68.52±12.67	67.66±11.81	0.05

Abbreviations: TACI, total anterior circulation infarct; PACI, partial anterior circulation infarct; POCI, posterior circulation infarct; LACI, lacunar infarct; mRS, modified Rankin Scale; TIA, transient ischemic attack; h, hours; NIHSS, National Institutes of Health Stroke Scale; IQR, interquartile range; min, minutes; rtPA, recombinant tissue plasminogen activator; INR, international normalized ratio.

Table 2 Clinical outcomes stratified by the Oxfordshire Community Stroke Project classification

Outcome	TACI (n=197)	PACI (n=700)	POCI (n=153)	LACI (n=65)	P-value
mRS 0–1 at 3 months (n, %)	45 (22.84)	359 (51.29)*	91 (59.48)*	50 (76.92)*,**	<0.001
mRS 0–2 at 3 months (n, %)	64 (32.49)	436 (62.29)*	100 (65.36)*	58 (89.23)*,**,***	<0.001
24–36 h SICH (n, %) (sich_sitsmost)	12 (6.09)	7 (1.00)*	1 (0.65)*	0 (0.00)	<0.001
24–36 h SICH (n, %) (sich_ecass2)	22 (11.17)	14 (2.00)*	4 (2.61)*	0 (0.00)*	<0.001
24–36 h SICH (n, %) (sich_ninds)	28 (14.21)	24 (3.43)*	5 (3.27)*	0 (0.00)*	<0.001
Mortality at 7 days (n, %)	32 (16.24)	11 (1.57)*	14 (9.15)**	0 (0.00)*	<0.001
Mortality at 3 months (n, %)	53 (26.90)	29 (4.26)*	27 (17.88)**	0 (0.00)*,***	<0.001

Notes: Chi-square (χ²) or Fisher’s exact test was used for post hoc multiple comparisons.

* P<0.008 compared to TACI,

** P<0.008 compared to PACI, and

*** P<0.008 compared to POCI.

Abbreviations: TACI, total anterior circulation infarct; PACI, partial anterior circulation infarct; POCI, posterior circulation infarct; LACI, lacunar infarct; mRS, modified Rankin Scale; h, hours; SICH, symptomatic intracerebral hemorrhage; SITS-MOST, Safe Implementation of Thrombolysis in Stroke-Monitoring Study.

Table 3 Logistic regression analysis of the clinical outcomes

Outcome	TACI n/N (%)	Non-TACI n/N (%)	Unadjusted analysis		Adjusted analysis
			Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value
SICH (SITS-MOST definition)	12/197 (6.09)	8/918 (0.87)	7.38 (2.98–18.30)	<0.001	8.80 (2.84–27.25)	<0.001
Mortality at 3 months	53/197 (26.90)	56/897 (6.24)	5.53 (3.65–8.37)	<0.001	5.24 (3.19–8.62)	<0.001
mRS 0–2 at 3 months	64/197 (32.49)	594/918 (64.70)	0.27 (0.20–0.38)	<0.001	0.38 (0.26–0.56)	<0.001

Notes: Adjusted for age, sex, body weight, current smoking habits, atrial fibrillation, history of TIA, hypertension, diabetes mellitus, blood glucose, systolic blood pressure, diastolic blood pressure, current medications (including anticoagulants/antiplatelets), NIHSS score upon admission, mean rtPA dose, and median stroke onset to treatment time. Non-TACI: PACI + POCI + LACI.

Abbreviations: TACI, total anterior circulation infarct; SICH, symptomatic intracerebral hemorrhage; SITS-MOST, Safe Implementation of Thrombolysis in Stroke-Monitoring Study; mRS, modified Rankin Scale; TIA, transient ischemic attack; NIHSS, National Institutes of Health Stroke Scale; rtPA, recombinant tissue plasminogen activator; PACI, partial anterior circulation infarct; POCI, posterior circulation infarct; LACI, lacunar infarct.

Figure 2 Distribution of modified Rankin Scale scores in patients with TACI and non-TACI.

Note: Non-TACI: PACI + POCI + LACI.
Abbreviations: TACI, total anterior circulation infarct; PACI, partial anterior circulation infarct; POCI, posterior circulation infarct; LACI, lacunar infarct.

Table 4 Logistic regression analysis for the clinical outcomes and interactions, according to the baseline NIHSS score

Outcomes	NIHSS ≤11		NIHSS >11		P for interactions
	Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value
SICH (SITS-MOST definition)	6.99 (0.17–288.08)	0.15	10.98 (2.63–45.86)	<0.01	0.51
Mortality at 3 months	3.63 (0.85–15.59)	0.18	5.05 (2.86–8.91)	<0.001	0.78
mRS 0–2 at 3 months	0.54 (0.25–1.15)	0.14	0.35 (0.22–0.55)	<0.001	0.69

Note: Adjusted for age, sex, body weight, current smoking habits, atrial fibrillation, history of TIA, hypertension, diabetes mellitus, blood glucose, systolic blood pressure, diastolic blood pressure, current medications (including anticoagulants/antiplatelets), NIHSS score upon admission, mean rtPA dose, and median stroke onset to treatment time.

Abbreviations: NIHSS, National Institutes of Health Stroke Scale; SICH, symptomatic intracerebral hemorrhage; SITS-MOST, Safe Implementation of Thrombolysis in Stroke-Monitoring Study; mRS, modified Rankin Scale; TIA, transient ischemic attack; rtPA, recombinant tissue plasminogen activator.