London, United Kingdom 2013 2 Acute stroke: current treatment Is thrombolysis in patients with mild stroke and patients > 80 years associated with positive outcome? Analysis of 2124 matched pairs of the Austrian Stroke Unit Registry S. Greisenegger1, J. Ferrari2, L. Seyfang3, W. Lang4 Department of Neurology, Medical University of Vienna, Vienna, AUSTRIA1, Department of Neurology, Hospital Barmherzige Brueder, Vienna, AUSTRIA2, Danube University Krems; Gesund-heit Österreich GmbH/BIQG, Vienna, AUSTRIA3, Department of Neurology, Hospital Barmherzige Brueder, Vienna, AUSTRIA4 BACKGROUND: Treatment with iv thrombolysis is not approved for patients with ischaemic stroke (IS) over 80 years of age, or patients with mild deficits, despite subgroup analyses from randomised studies and observational data pointing to a benefit also for those patient groups. We analysed the efficacy of iv thrombolysis in a matched-pairs analysis of patients with- and without iv thrombolysis over all age groups and the whole range of stroke severity in a large cohort of patients with isch-aemic stroke (Austrian stroke Unit Registry, ASUR). METHODS: Patients with and without therapy with iv rtPA were matched for age, gender, pre stroke disability (according to the mRS), stroke se-verity (according to the NIHSS), hypertension, diabetes mellitus, hypercholesterolemia, etiology and clinical stroke syndrome. Outcome was assessed by the mRS at three months. Means of outcome differences in the matched pairs were used for interpretation. For data-visualisation weighted aver-ages of the outcome differences were computed for all age-severity combinations along a grid and mapped to a color. For weighting the truncated Gaussian bell curve was used. Finally, color mapping was used based on six ranges. RESULTS: Of 60230 patients with IS prospectively enrolled into the ASUR, 7615 were treated with iv rtPA. Of those 1927 (25.3%) were >80 years and 1378 (18.1%) had a mild deficit (NIHSS ≤ 4). 2124 matched pairs were included into the final analysis. Visual-isation of the data by colour mapping showed a more favourable outcome in patients treated with thrombolysis as compared to matched cases over all ages and the whole range of stroke severity. Ef-fect sizes in thrombolysed patients with mild stroke were smaller but still superior compared to the matched cases. These findings applied to all analysed subgroups. CONCLUSION: In our study pa-tients treated with thrombolysis with mild deficit or >80 years had a better outcome after 3 months than matched cases without thrombolysis. E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 221 E-Poster Terminal 1 1 Acute stroke: current treatment IV thrombolysis and renal function H. Gensicke1, SM Zinkstok2, P. Ringleb3, V. Artto4, D. Leys5, P. Michel6, J. Berrouschot7, M. Ar-nold8, A. Zini9, G. Bigliardi10, V. Padjen11, A. Pezzini12, J. Putaala13, PJ Nederkoorn14, ST Engelter15 University Hospital Basel, Basel, SWITZERLAND1, Academic Medical Center University of Amsterdam, Amsterdam, THE NETHERLANDS2, University of Heidelberg, Heidelberg, GERMA-NY3, Helsinki University Central Hospital, Helsinki, FINLAND4, University Lille North de France, UDSL (EA1046), Lille, FRANCE5, Centre Hospitalier Universitaire Vaudois and University of Lau-sanne, Lausanne, SWITZERLAND6, Municipal Hospital Altenburg, Altenburg, GERMANY7, Uni-versity Hospital Bern, Bern, SWITZERLAND8, AUSL Modena, Modena, ITALY9, AUSL Modena, Modena, ITALY10, Clinical Center, School of Medicine, University of Belgrade, Belgrade, SERBIA11, University Hospital Brescia, Brescia, ITALY12, Helsinki University Central Hospital, Helsinki, FINLAND13, Academic Medical Center University of Amsterdam, Amsterdam, THE NETHERLANDS14, University Hospital Basel, Basel, SWITZERLAND15 Objective: To investigate the association of renal function on functional outcome and complications in stroke patients treated with IV-thrombolysis (IVT). Methods: In this pooled observational study of 11 IVT-databases we compared the estimated glo-merular filtration rate (GFR) with the following primary outcome measures: poor 3-month out-come (modified Rankin scale 3–6), death and symptomatic ICH (sICH) based on the criteria of the ECASS-II trial. Unadjusted and adjusted odds ratios with 95% confidence intervals (OR 95%CI) were calculated. Results: Among 4780 IVT-treated stroke patients, 1217 (25.5%) had a low GFR (<60 ml/ min/1.73m²). A decrease in GFR by 10 ml/min/1.73m2 increased the risk of poor outcome (ORun-adjusted 1.201.17-1.24; ORadjusted 1.051.01-1.09, death (ORunadjusted 1.331.28-1.38; OR-adjusted 1.181.11-1.25 and sICH (ORunadjusted 1.151.01-1.22; ORadjusted 1.121.04-1.20. As a categorical variable, a low GFR was independently associated with poor 3-month outcome (ORadjusted 1.341.12-1.61) and death (ORadjusted 1.73, 95%CI 1.39-2.14,) and sICH (ORadjust-ed 1.651.22-2.25) compared with normal GFR (60-120 ml/min/1.73m²). Low GFR (ORadjusted 1.651.22-2.25) and stroke severity (ORadjusted 1.051.03-1.07) independently determined sICH, while all other co-variates including age did not. After adjustment renal hyperfiltration (GFR >120 ml/min/1.73m2) was not associated with poor outcome, death or sICH. Conclusion: Renal function significantly modified outcome and complication rates in stroke patients treated with IVT. Furthermore, lower GFR might be a better risk indicator for sICH than age. A de-crease of GFR by 10 ml/min/1.73m2 seems to have a similar impact on the risk of death or sICH as an one-point higher National Institutes of Health Stroke Scale-score measuring stroke severity.
Karger_ESC London_2013
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