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Published on: November 26, 2013
Cerebral thrombolysis in patients with ischemic stroke and heart failure
Piotr Sobolewski1, Grzegorz Kozera2, Wiktor Szczuchniak3
1The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland; Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Poland.
Insights
Heart failure (HF) presence does not impact outcomes or safety in ischemic stroke patients receiving intravenous thrombolysis. This finding holds true regardless of whether HF is defined by old or new criteria, suggesting HF is not a predictor of treatment efficacy.
Area of Science:
- Neurology
- Cardiology
Background:
- Heart failure (HF) is prevalent in ischemic stroke (IS) patients.
- The impact of HF on outcomes after intravenous thrombolysis (iv-thrombolysis) remains unclear.
- Recent modifications to HF definitions necessitate re-evaluation in stroke studies.
Purpose of the Study:
- To assess the relationship between HF (using old and new definitions) and long-term outcomes in IS patients treated with iv-thrombolysis.
- To evaluate the impact of HF on mortality and hemorrhagic complications post-iv-thrombolysis.
- To determine if HF influences the safety and efficacy of iv-thrombolysis for acute IS.
Main Methods:
- Retrospective analysis of 328 Caucasian patients with IS treated with iv-thrombolysis.
- HF classification based on both old and new diagnostic criteria.
- Long-term outcome assessment using modified Rankin Scale (mRS) at 90 days.
- Mortality rate and hemorrhagic complications were recorded.
Main Results:
- No significant difference in HF incidence was observed between favorable (mRS 0-2) and unfavorable (mRS 3-6) outcomes for either HF definition.
- HF presence did not correlate with survival rates at 90 days post-stroke.
- Multivariate analysis confirmed no impact of HF diagnosis on patient outcome or mortality (p > 0.05).
Conclusions:
- Systolic heart failure, by either old or new definitions, does not predict the safety or efficacy of intravenous thrombolysis in ischemic stroke patients.
- HF status does not appear to be a determining factor for treatment success or complications in this patient cohort.
Background:
Heart failure (HF) is common among patients with ischemic stroke (IS), however its impact on outcome after iv-thrombolysis has not been fully determined. Moreover, definition of HF has been recently modified, but majority of stroke studies classified patients regarding an old HF criteria. Thus, the aim of our study was to evaluate the relationship between both, newly and formerly defined HF and the long-term outcome, mortality and the presence of hemorrhagic complications in patients with acute IS treated with iv-thrombolysis.
Methods:
We retrospectively evaluated data from 328 Caucasian patients with IS consecutively treated with iv-thrombolysis. HF was defined according to old and new definition; long-term outcome was assessed with modified Rankin Scale (mRS) score and mortality rate on 90th days after IS.
Results:
The incidence of HF did not differ between patients with favorable (mRS 0-2) and unfavorable (mRS 3-6) functional outcome respectively for the old and for the new definition (10.4% vs. 15.5, p = 0.17; 17.4% vs. 18.1%, p = 0.88) and between those who survived and died within 90 days after IS (11.7% vs. 20.0%, p = 0.27; 17.2% vs. 25.0%, p = 0.38, respectively). Multivariate analysis showed no impact of HF diagnosis on outcome (p = 0.94) or mortality (p = 0.64).
Conclusion:
The presence of systolic HF, defined according to an old and a new definition, does not determine safety and efficacy of cerebral iv-thrombolysis in patients with IS.
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