Abstract T P70: Outcome of Japanese Minor Stroke Patients Treated Without Intravenous Recombinant Tissue Plasminogen Activator Within 4.5 Hours After the Symptom Onset ~Fukuoka Stroke Registry~

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Background & Purpose: Patients with minor stroke with the initial NIH stroke scale score of 4 or less were often treated without recombinant tissue plasminogen activator (rt-PA) even when they are admitted within 4.5 hours after the symptom onset. We investigated the outcome of minor stroke within 4.5 hours after the symptom onset without intravenous recombinant tissue plasminogen activator therapy. Methods: Among consecutive 6246 acute ischemic stroke patients who were admitted to the 7 stroke centers, 963 patients with admission within 4.5 hours after the symptom onset, ischemic lesions on diffusion-weighted image, NIH stroke scale of 4 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. Thirty-four (3.5%) of the 963 patients were treated with intravenous rt-PA. In other 926 patients, we observed a neurological deterioration (a NIHSS score worsening of ≥2-point) and stroke recurrence during the first 3 weeks. A good outcome (3 months) at was defined as mRS of 0 or 1. Results: Stroke recurrence and neurological deterioration occurred in 3.7% and 9.2% of 926 patients during the first 3 weeks. A good outcome 3 months after admission was observed in 82.3%. Atrial fibrillation and diabetes mellitus were less frequent in patients with than without a good outcome. The initial NIH stroke scale score, LDL-cholesterol, glucose, HbA1c, d-dimer, and CRP values were lower, and the initial HDL-cholesterol and estimated GFR values were higher in patients with than without a good outcome. On multivariate analysis, age (OR 0.94, 95%CI 0.92~0.97), the initial NIH stroke scale score (OR 0.60, 95%CI 0.48~0.74), LDL-cholesterol (OR 0.99, 95%CI 0.98~1.00), and D-dimer (OR 0.92, 95%CI 0.85~0.99) were negatively associated with a good outcome. With regard to the ROC curve analysis, the most accurate cut-off value for predicting a good outcome was 74 years in age, 2 in NIH stroke scale score, 137mg/ml in LDL-cholesterol, and 0.80μg/ml in D-dimer. Conclusions: In minor stroke patients treated without rt-PA, age of 75 years or more, NIH stroke scale score of 3 or more, LDL-cholesterol of 138mg/ml or more, or D-dimer of 0.80μg/ml or more could be negative predictor for a good outcome. In such patients, treatment with rt-PA may be considered.

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