Introduction & Hypothesis: Data on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes.
Methods: Telephone interviews were used to assess the to the the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy after written informed consent was obtained. When a telephone interview was not successfully accomplished, an interview letter was sent as an alternative method. Favorable outcome was defined as mRS 0-2, and unfavorable outcome was as mRS 3-6. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy.
Results: From 2005 to 2013, 256 (median age, 77 [interquartile range, 68-84] years; 157 [61%] males) patients were enrolled. The onset-to-treatment time (OTT) was 153 (120-176) minutes. At 3 months after tPA therapy, the median mRS score was assessed as 3 (1-5). Kaplan-Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% patients and that the mortality rate was 40%. Univariate analysis showed that OTT was 123 (107-172) minutes in patients with favorable outcomes and 155 (124-172) minutes in patients with non-favorable outcomes (p=0.046). In addition, OTT was 157 (133-172) minutes in the death group and 123 (106-169) minutes in the survival group (p=0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.97, 95% confidence interval 0.95-0.99, p=0.008) and mortality (odds ratio 1.04, 95% confidence interval 1.02-1.06, p=0.001). Receiver operating characteristic curve analysis showed that OTT ≥ 136 minutes was the optimal cut-off value to predict favorable outcome at 5 years after tPA therapy, with a sensitivity of 0.67, a specificity of 0.70, and an area under curve (AUC) of 0.662 (p=0.016), and that to predict death within 5 years after tPA therapy, with a sensitivity of 0.70, a specificity of 0.66, and an AUC of 0.679 (p=0.001).
Conclusion: Early tPA administration can improves long-term clinical outcomes.