Original Article| Volume 23, ISSUE 2, P367-373, February 2014

The iScore Predicts Clinical Response to Tissue Plasminogen Activator in Korean Stroke Patients


      Despite substantial differences in clinical features between Asian and Western stroke patients, there are no published prognostic tools validated in an Asiatic population for thrombolytic therapy. We assessed the ability of the iScore to predict the clinical response after intravenous thrombolysis with tissue plasminogen activator (tPA) in a Korean stroke population.


      We applied the iScore to eligible participants in the nationwide multicenter stroke registry in Korea. Main outcome measures were poor functional outcome defined as having a modified Rankin Scale score 3-6 and death at 3 months. Symptomatic intracranial hemorrhage (sICH) was evaluated as a safety outcome. C statistic was calculated to assess performance of iScore.


      Among 4760 patients with an acute ischemic stroke, 622 (13.1%) received tPA, 548 patients had complete information for the analysis. C statistics for poor functional outcome and death at 3 months were .813 (95% confidence interval [CI]: .778-.848) and .820 (95% CI: .769-.872), respectively. Overall, there was a high correlation between observed and expected outcome for poor functional outcome (Pearson correlation coefficient, r = .982) and for death at 3 months (r = .950) at the risk score level. An iScore of 180 or more was associated with a more than 2 times risk of poor functional outcome and about 6 times risk of death at 3 months. There was an interaction between the iScore and tPA for a poor functional outcome (P value for the interaction < .001). We found a gradient effect in the incident risk of sICH with the iScore.


      The iScore reliably predicts stroke outcomes after tPA in Asiatic population.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.
        N Engl J Med. 1995; 333: 1581-1587
        • Hacke W.
        • Donnan G.
        • Fieschi C.
        • et al.
        Association of outcome with early stroke treatment: Pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
        Lancet. 2004; 363: 768-774
        • Wardlaw J.M.
        • Murray V.
        • Berge E.
        • et al.
        Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis.
        Lancet. 2012; 379: 2364-2372
      2. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t- PA Stroke Study Group.
        Stroke. 1997; 28: 2109-2118
        • Kruetzelmann A.
        • Kohrmann M.
        • Sobesky J.
        • et al.
        Pretreatment diffusion-weighted imaging lesion volume predicts favorable outcome after intravenous thrombolysis with tissue-type plasminogen activator in acute ischemic stroke.
        Stroke. 2011; 42: 1251-1254
        • Saqqur M.
        • Uchino K.
        • Demchuk A.M.
        • et al.
        Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke.
        Stroke. 2007; 38: 948-954
        • Strbian D.
        • Meretoja A.
        • Ahlhelm F.J.
        • et al.
        Predicting outcome of IV thrombolysis-treated ischemic stroke patients: the DRAGON score.
        Neurology. 2012; 78: 427-432
        • Kent D.M.
        • Selker H.P.
        • Ruthazer R.
        • et al.
        The stroke-thrombolytic predictive instrument: a predictive instrument for intravenous thrombolysis in acute ischemic stroke.
        Stroke. 2006; 37: 2957-2962
        • Cucchiara B.
        • Tanne D.
        • Levine S.R.
        • et al.
        A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke.
        J Stroke Cerebrovasc Dis. 2008; 17: 331-333
        • Lou M.
        • Safdar A.
        • Mehdiratta M.
        • et al.
        The HAT score: a simple grading scale for predicting hemorrhage after thrombolysis.
        Neurology. 2008; 71: 1417-1423
        • Mazya M.
        • Egido J.A.
        • Ford G.A.
        • et al.
        Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe implementation of treatments in stroke (SITS) symptomatic intracerebral hemorrhage risk score.
        Stroke. 2012; 43: 1524-1531
        • Menon B.K.
        • Saver J.L.
        • Prabhakaran S.
        • et al.
        Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator.
        Stroke. 2012; 43: 2293-2299
        • Strbian D.
        • Engelter S.
        • Michel P.
        • et al.
        Symptomatic intracranial hemorrhage after stroke thrombolysis: the SEDAN score.
        Ann Neurol. 2012; 71: 634-641
        • Saposnik G.
        • Kapral M.K.
        • Liu Y.
        • et al.
        iScore: a risk score to predict death early after hospitalization for an acute ischemic stroke.
        Circulation. 2011; 123: 739-749
        • Saposnik G.
        • Fang J.
        • Kapral M.K.
        • et al.
        The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke.
        Stroke. 2012; 43: 1315-1322
        • Nilanont Y.
        • Komoltri C.
        • Saposnik G.
        • et al.
        The Canadian Neurological Scale and the NIHSS: development and validation of a simple conversion model.
        Cerebrovasc Dis. 2010; 30: 120-126
        • Saposnik G.
        • Demchuk A.
        • Tu J.V.
        • et al.
        The iScore predicts efficacy and risk of bleeding in the National Institute of Neurological Disorders and Stroke tissue plasminogen activator stroke trial.
        J Stroke Cerebrovasc Dis. 2012; ([published online ahead of print October 24. 2012])
        • Hsieh F.I.
        • Lien L.M.
        • Chen S.T.
        • et al.
        Get With The Guidelines-Stroke performance indicators: surveillance of stroke care in the Taiwan stroke registry: Get With The Guidelines-Stroke in Taiwan.
        Circulation. 2010; 122: 1116-1123
        • Zhang N.
        • Liu G.
        • Zhang G.
        • et al.
        A risk score based on Get With The Guidelines-Stroke program data works in patients with acute ischemic stroke in China.
        Stroke. 2012; 43: 3108-3109
        • Wahlgren N.
        • Ahmed N.
        • Davalos A.
        • et al.
        Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study.
        Lancet. 2007; 369: 275-282
        • Sandercock P.
        • Wardlaw J.M.
        • Lindley R.I.
        • et al.
        The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial.
        Lancet. 2012; 379: 2352-2363
        • Saposnik G.
        • Raptis S.
        • Kapral M.K.
        • et al.
        The iScore predicts poor functional outcomes early after hospitalization for an acute ischemic stroke.
        Stroke. 2011; 42: 3421-3428
        • Whiteley W.N.
        • Slot K.B.
        • Fernandes P.
        • et al.
        Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies.
        Stroke. 2012; 43: 2904-2909