Early administration of tissue-plasminogen activator improves the long-term clinical outcome at 5 years after onset

• We studied rates of favorable outcome and mortality at 5 years after tPA therapy.
• The mRS score was assessed at 3 and 6 months, and 1 to 5 years after tPA therapy.
• Kaplan–Meier curve showed that favorable outcome rate was 45% and mortality was 40%.
• Onset-to-treatment time was independently related to favorable outcome and mortality.
• Early tPA administration can improve long-term clinical outcomes.

Background and purposeData on long-term outcomes after tissue-plasminogen activator (tPA) therapy are limited. We evaluated the rate of favorable outcomes and mortality at 5 years after tPA therapy and investigated factors related to long-term clinical outcomes.MethodsTelephone interviews or interview letters were used to assess the modified Rankin Scale (mRS) scores at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after tPA therapy. Favorable outcome was defined as mRS 0–2. Multivariate logistic regression analysis was conducted to investigate factors associated with favorable outcomes and mortality at 5 years after tPA therapy.ResultsFrom 2005 to 2013, 256 (median age, 77 [interquartile range, 68–84] years; 157 [61%] males; median National Institutes of Health Stroke Scale score, 11 [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17] and [18]) patients were enrolled. Kaplan–Meier curve showed that favorable outcomes after 5 years after tPA therapy occurred in 45% of the patients and that the mortality rate was 40%. Univariate analysis showed that onset-to-treatment time (OTT) was 121 (107–172) minutes in patients with favorable outcomes and 156 (126–171) minutes in patients with unfavorable outcomes (p = 0.016). In addition, OTT was 157 (133–172) minutes in the death group and 123 (106–169) minutes in the survival group (p = 0.001). Multivariate regression analysis indicated that OTT was an independent factor related to favorable outcomes (odds ratio 0.96, 95% confidence interval 0.93–0.99, p = 0.004) and mortality (odds ratio 1.04, 95% confidence interval 1.02–1.06, p = 0.001).ConclusionEarly tPA administration can improve long-term clinical outcomes.