Original Article| Volume 24, ISSUE 8, P1787-1792, August 2015

Intravenous Thrombolysis with Recombinant Tissue-type Plasminogen Activator for Acute Ischemic Stroke in Patients with Metabolic Syndrome


      The metabolic syndrome (MetS) is common in patients with acute ischemic stroke (IS); however, its impact on outcome after intravenous thrombolysis (iv-thrombolysis) remains unclear. Thus, we aimed at evaluating the relationship between MetS and functional long-term outcome, mortality, and the presence of hemorrhagic complications in patients with IS treated with iv-thrombolysis.


      We retrospectively evaluated the demographic and clinical data of 535 Caucasian patients with acute IS who were consecutively treated with iv-thrombolysis from September 2006 to June 2013 in 2 experienced stroke centers in Poland. A favorable functional long-term outcome was defined as a modified Rankin scale score less than or equal to 2 points on day 90, and hemorrhagic complications were assessed with European Cooperative Acute Stroke Study criteria.


      MetS was recognized in 192 (35.9%) patients (44.8% men; mean age, 70.8 ± 11.1 years), diabetes in 29.7%, dyslipidemia in 79.2%, and arterial hypertension in 75.5%. At 3 months, favorable outcome was found in 55.3% of patients, symptomatic intracerebral hemorrhage (SICH) in 18.3%, and 4.4 % of patients died. There was no difference regarding the presence of favorable outcome between patients with and without MetS (52.6% versus 56.9%, P = .34). The presence of SICH and 3-month mortality were more frequent in patients with MetS than without MetS (6.8% versus 2.9%, P = .03 and 23.4% versus 15.5%, P = .02, respectively); however, a multivariate analysis showed no impact of MetS on mortality or SICH.


      Results of our study provide no data to suggest that the effect of intravenous tissue-type plasminogen activator differs based on the presence or absence of MetS.

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        • Ford G.S.
        • Giles W.H.
        • Mokdad A.H.
        Increasing prevalence of the metabolic syndrome among US adults.
        Diabetes Care. 2004; 27: 2444-2449
        • Balkau B.
        • Vernay M.
        • Mhamdi L.
        • et al.
        • D.E.S.I.R. Study Group
        The incidence and persistence of the NCEP (National Cholesterol Education Program) metabolic syndrome. The French D.E.S.I.R. study.
        Diabetes Metab. 2003; 29: 526-532
        • Wyrzykowski B.
        • Zdrojewski T.
        • Sygnowska E.
        • et al.
        Epidemiology of metabolic syndrome in Poland. The results of “WOBASZ” study.
        Kardiol Pol. 2005; 63: 1-4
        • Wassink A.M.
        • van der Graaf Y.
        • Olijhoek J.K.
        • et al.
        • SMART Study Group
        Metabolic syndrome and the risk of new vascular events and all-cause mortality in patients with coronary artery disease, cerebrovascular disease, peripheral arterial disease or abdominal aortic aneurysm.
        Eur Heart J. 2008; 29: 213-223
        • Olijhoek J.K.
        • van der Graaf Y.
        • Banga J.D.
        • et al.
        • the SMART Study Group
        The metabolic syndrome is associated with advanced vascular damage in patients with coronary heart disease, stroke, peripheral arterial disease or abdominal aortic aneurysm.
        Eur Heart J. 2004; 25: 342-348
        • Bonora E.
        • Kiechl S.
        • Willeit J.
        • et al.
        • Bruneck Study
        Carotid atherosclerosis and coronary heart disease in the metabolic syndrome: prospective data from the Bruneck study.
        Diabetes Care. 2003; 26: 1251-1257
        • Balletshofer B.M.
        • Rittig K.
        • Stock J.
        • et al.
        Insulin resistant young subjects at risk of accelerated atherosclerosis exhibit a marked reduction in peripheral endothelial function early in life but not differences in intima-media thickness.
        Atherosclerosis. 2003; 171: 303-309
        • Maruyama K.
        • Uchiyama S.
        • Iwata M.
        Metabolic syndrome and its components as risk factors for first-ever acute ischemic noncardioembolic stroke.
        J Stroke Cerebrovasc Dis. 2009; 18: 173-177
        • Anand S.S.
        • Yi Q.
        • Gerstein H.
        • et al.
        • Study of Health Assessment and Risk in Ethnic Groups. Study of Health Assessment and Risk Evaluation in Aboriginal Peoples Investigators
        Relationship of metabolic syndrome and fibrinolytic dysfunction to cardiovascular disease.
        Circulation. 2003; 108: 420-425
        • Oh M.Y.
        • Ko S.B.
        • Lee S.H.
        • et al.
        Association between metabolic syndrome and functional outcome in patients with acute ischaemic stroke.
        Eur J Neurol. 2014; 21: 177-179
        • Koren-Morag N.
        • Goldbourt U.
        • Tanne D.
        Relation between the metabolic syndrome and ischemic stroke or transient ischemic attack: a prospective cohort study in patients with atherosclerotic cardiovascular disease.
        Stroke. 2005; 36: 1366-1371
        • Li W.
        • Ma D.
        • Liu M.
        • et al.
        Association between metabolic syndrome and risk of stroke: a meta-analysis of cohort studies.
        Cerebrovasc Dis. 2008; 25: 539-547
        • Yasar A.S.
        • Bilen E.
        • Bilge M.
        • et al.
        Impact of metabolic syndrome on coronary patency after thrombolytic therapy for acute myocardial infarction.
        Coron Artery Dis. 2009; 20: 387-391
        • Uchida Y.
        • Ichimiya S.
        • Ishii H.
        • et al.
        Impact of metabolic syndrome on various aspects of microcirculation and major adverse cardiac events in patients with ST-segment elevation myocardial infarction.
        Circ J. 2012; 76: 1972-1979
        • Arenillas J.F.
        • Ispierto L.
        • Millán M.
        • et al.
        Metabolic syndrome and resistance to IV thrombolysis in middle cerebral artery ischemic stroke.
        Neurology. 2008; 71: 190-195
        • Arenillas J.F.
        • Sandoval P.
        • Pérez de la Ossa N.
        • et al.
        The metabolic syndrome is associated with a higher resistance to intravenous thrombolysis for acute ischemic stroke in women than in men.
        Stroke. 2009; 40: 344-349
        • Calleja A.I.
        • Garcia-Bermejo P.
        • Cortijo E.
        • et al.
        Insulin resistance is associated with a poor response to intravenous thrombolysis in acute ischemic stroke.
        Diabetes Care. 2011; 34: 2413-2417
        • Członkowska A.
        • Sarzynska-Długosz I.
        • Niewada M.
        • et al.
        Eligibility of stroke units in Poland for administration of intravenous thrombolysis.
        Eur J Neurol. 2006; 13: 220-224
        • Adams H.P.
        • del Zoppo G.
        • Alberts M.J.
        • et al.
        Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
        Circulation. 2007; 115: e478-e534
      1. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008.
        Cerebrovasc Dis. 2008; 25: 457-507
        • Lyden P.
        • Brott T.
        • Tilley B.
        • et al.
        Improved reliability of the NIH Stroke Scale using video training. NINDS TPA Stroke Study Group.
        Stroke. 1994; 25: 2220-2226
        • Hacke W.
        • Kaste M.
        • Bluhmki E.
        • et al.
        • for the ECASS Investigators
        Thrombolysis with alteplase 3 to 4.5 hours after acute ischaemic stroke.
        N Engl J Med. 2008; 359: 1317-1329
        • Wahlgren N.
        • Ahmed N.
        • Dávalos A.
        • et al.
        • for the SITS investigators
        Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study.
        Lancet. 2008; 372: 1303-1309
        • Zoppo G.J.
        • Saver J.L.
        • Jauch E.C.
        • et al.
        Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association.
        Stroke. 2009; 40: 2945-2948
        • Bonita R.
        • Beaglehole R.
        Recovery of motor function after stroke.
        Stroke. 1988; 19: 1497-1500
        • Hacke W.
        • Kaste M.
        • Fieschi C.
        • et al.
        Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators.
        Lancet. 1998; 352: 1245-1251
        • Grundy S.M.
        • Cleeman J.I.
        • Daniels S.R.
        • et al.
        Diagnosis and management of the metabolic syndrome. An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement American Heart Association.
        Circulation. 2005; 112: 2735-2752