Background
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.
Methods
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.
Results
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.
Conclusion
The iScore reliably predicts stroke outcomes after tPA in Asiatic population.
Key Words
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Article info
Publication history
Published online: June 24, 2013
Accepted:
May 19,
2013
Received in revised form:
May 14,
2013
Received:
April 2,
2013
Footnotes
Contributors—T.H.P. contributed to the study concept, design, acquisition of data, and primary writing. G.S. contributed to the study concept, design, interpretation, critical revision of the manuscript for important intellectual content and supervised this study. J.S.L. and J.L. contributed to statistical analysis and interpretation. K.K., J.-M.P., K.B.L., Y.-J.C., M.-K.H., S.-S.P., Y.K., S.L., J.L., J.C.C., D.-E.K., K.-S.H., J.-T.K., D.-H.K., J.-K.C., K.-H.Y., B.-C.L., B.-W.Y., and H.-J.B. contributed to the acquisition of data.
Funding: This work was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare and Family Affairs, and the Republic of Korea (A102065). G.S. is supported by the Distinguished Clinician Scientist Award from Heart and Stroke Foundation of Canada.
Conflict of interest: The authors have no conflicts of interest.
Disclosure: None for all authors.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.05.025
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
