Page 110 - Read Online
P. 110

and NIHSS, international normalized ratio, high     13 vs.14), which had been proven to be the most important
                                                                                         [9]
           sensitivity C reactive protein, heart failure, diabetes   determinant of stroke mortality.  Although Asian ethnic
           and interaction of NIHSS and  thrombolysis  in  Cox   patients in US had higher mortality rate in hospital stay
           regression, thrombolysis in AIS showed an independent   after  thrombolysis,   and  we  too  previously  reported  a
                                                                              [10]
           protective effect for longer period of favorable outcome   higher 3-month mortality rate of 18%  than that in western
                                                                                            [11]
           [202 vs. 151 weeks, P = 0.026, heart rate (HR) 1.96, 95%   countries,  further study should be performed to clarity the
                                                                      [12]
           CI 1.958-3.540]. While adjusted for factors of white blood   potential benefits of thrombolysis for long-term survival in
           cell count, onset to treatment time and serum bicarbonate   Chinese patients, with prospective design and less bias.
           level, serum creatinine level and interaction of NIHSS
           and white blood cell count additionally, thrombolysis   Financial support and sponsorship
           itself might be an independent predictor for longer   Nil.
           survival instead  (333  vs. 170 weeks,  P = 0.000, HR
           4.322, 95% CI 1.942-9.618) [Figures 1 and 2]. The   Conflicts of interest
           estimated proportion of favorable outcome was about   There are no conflicts of interest.
           91% for 1 year and 50% for about 3.4 years (4.2 vs. 3.1),
           while the estimated proportion of survival was about   REFERENCES
           98.5% for 1 year and 50% for about 5.3 years (6.9 vs.   1.   Group TIC. Effect of thrombolysis with alteplase within 6 h of acute
           3.5).                                                  ischaemic stroke on long-term outcomes (the third International Stroke Trial
                                                                  [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurol
           DISCUSSION                                             2013;12:768-76.
                                                               2.   Wang Y, Liao X, Zhao X, Wang DZ, Wang C, Nguyen-Huynh MN, Zhou
                                                                  Y, Liu L, Wang X, Liu G, Li H, Wang Y; China National Stroke Registry
           In this hospital-based retrospective cohort study, we found   Investigators. Using recombinant tissue plasminogen activator to treat acute
           thrombolysis with alteplase might have a protective effect   ischemic stroke in  China: analysis of the results from the Chinese National
           for longer period of time of favorable outcome and survival   Stroke Registry (CNSR). Stroke 2011;42:1658-64.
                                                                  Fang XH, Wang WH, Zhang XQ, Liu HJ, Zhang HM, Qin XM, Wang
           in Chinese AIS patients. To our knowledge, this is the first   3.   ZC, Ji XM, Li LM. Incidence and survival of symptomatic lacunar
           observational survey that compared the long-term prognoses   infarction in a Beijing population: a 6-year prospective study. Eur J
           of thrombolysis and anti-platelet therapy in mainland China.   Neurol 2012;19:1114-20.
           The  overall  estimated  five-year survival  rate  was  50%,   4.   Wang Y, Liao X, Zhao X, Wang C, Liu L, Zhou Y, Wang C, Xue J, Gao P,
                                                                  Dong K, Ji X, Wang Y; ITAIS-II investigators. Imaging-based thrombolysis
                                   [5]
                                             [6]
           comparable to published data.  Wang et al.  found one-year   trial in acute ischemic stroke-II (ITAIS-II). Int J Stroke 2009;4:49-53.
           survival rate of hospitalized AIS patients was about 89.2% in   5.   Askoxylakis V, Thieke C, Pleger ST, Most P, Tanner J, Lindel K, Katus HA,
           west China, much lower than that one in our cohort (98.5%).   Debus J, Bischof M. Long-term survival of cancer patients compared to
                                                                  heart failure and stroke: a systematic review. Bmc Cancer 2010;10:105.
           This may due to the fact that they enrolled patients with   6.   Wang D, Hao Z, Tao W, Kong F, Zhang S, Wu B, Lin S, Liu M. Acute ischemic
           symptoms onset within 14 days. Much of them might not   stroke in the very elderly Chinese: risk factors, hospital management and
           have received timely thrombolytic or anti-platelet therapies.   one-year outcome. Clin Neurol Neurosurg 2011;113:442-6.
           With time elapsed, stroke might progress and leading to a   7.   Wang L, Chao Y, Zhao X, Liu L, Wang C, Wang DZ, Meng X, Wang A,
                                                                  Wang Y, Xu Y. Factors associated with delayed presentation in patients with
           worse end. Notably, much of patients in their data set were   TIA and minor stroke in China: analysis of data from the China National
           mild stroke (median NIHSS score 5) with high proportion   Stroke Registry (CNSR). Neurol Res 2013;35:517-21.
           of small artery occlusion (42.9%), while we enrolled more   8.   Gensicke H, Seiffge DJ, Polasek AE, Peters N, Bonati LH, Lyrer PA, Engelter
                                                                  ST. Long-term outcome in stroke patients treated with IV thrombolysis.
           severe patients (median NIHSS score 9) with 70.8% large   Neurology 2013;80: 919-25.
           artery occlusion sub-type. These results might remind   9.   Schwamm LH, Fonarow GC, Reeves MJ, Pan W, Frankel MR, Smith
           the importance of timely and fully managements of mild   EE, Ellrodt G, Cannon CP, Liang L, Peterson E, Labresh KA. Get With
                                                                  the Guidelines-Stroke is associated with sustained improvement in care
           stroke, which is more common in Chinese population with   for patients hospitalized with acute stroke or transient ischemic attack.
           unfavorable outcome,  to reach a longer survival.      Circulation 2009;119:107-15.
                            [3,7]
                                                               10.  Nasr  DM,  Brinjikji  W, Cloft  HJ,  Rabinstein  AA. Racial and  ethnic
           Compared to that of Gensicke et al.  in Switzerland, Chinese   disparities in the use of intravenous recombinant tissue plasminogen
                                      [8]
           AIS patients received thrombolytic therapy seemed to have   activator and outcomes for acute ischemic stroke. J Stroke Cerebrovasc
                                                                  Dis 2013;22:154-60.
           longer 50% survival time (6.9 vs. 4.0 years) and good outcome   11.  Niantong L, Ling C, Biping Y. Predictors of mortality in acute ischemic stroke
           (4.2 vs. 3.0 years). We cannot make a conclusion due to the   patients with thrombolysis. Shi Yong Yi Xue Za Zhi 2013;2861-3.
           disparities of pre-defined endpoint (mRs 0-1 in Swiss vs. 0-2   12.  O’Rourke KE, Walsh CD, Kelly PJ. Safety and efficacy of IV-TPA for
                                                                  ischaemic stroke in clinical practice--a Bayesian analysis. Cerebrovasc Dis
           in CHN) but the stroke severity was comparable (NIHSS   2009;28:572-81.












           Neuroimmunol Neuroinflammation | Volume 3 | April 19, 2016                                       101
   105   106   107   108   109   110   111   112   113   114   115