Natural history of TPA-untreated minor stroke in the North Dublin population stroke study

Hdl Handle:
http://hdl.handle.net/10147/240273
Title:
Natural history of TPA-untreated minor stroke in the North Dublin population stroke study
Authors:
Marnane, M; Callaly, E; Hannon, N; Merwick, A; Ni Chroinin, D; Sheehan, O; Duggan, J; Moroney, J; Williams, D; McCormack, P M E; Murphy, S; Dolan, E; O'Rourke, K; Lynch, T; Kelly, PJ
Citation:
Cerebrovascular Diseases (2011) 31 SUPPL. 2 (62). : May 2011
Publisher:
Karger
Journal:
Cerebrovascular Diseases
Issue Date:
May-2011
URI:
http://hdl.handle.net/10147/240273
Abstract:
Introduction: Current guidelines recommend caution when considering emergency tissue plasminogen activator (tPA) therapy for patients with minor neurological deficits. However few data exist regarding the “natural history” (without tPA) of stroke in unselected population-based cohorts. We sought to evaluate the risk of long term disability in “minor stroke” patients. Methods: In the 294,529 residents of North Dublin we prospectively identified all transient ischaemic attacks (TIAs) and ischaemic strokes over a 1 year period in 2005-06, immediately before a regional stroke thrombolysis service was begun. National Institutes of Health Stroke Scale (NIHSS) at presentation and functional status (modified Rankin Score, mRS) at 90 days and 1 year were assigned by trained investigators. Results: 478 patients were identified. 37.4% (179/478) had TIA or NIHSS=0 at presentation, 31.4% (150/478) had minor stroke (NIHSS=1-4), and 31.2% (149/478) had moderate/severe stroke (NIHSS=5-42). By 90 days, 34% of minor stroke patients had some disability (mRS≥2) (vs. 9.7% TIA/NIHSS=0, p<0.0001) and 16.7% had at least moderate disability (mRS≥3) (vs 6.4% TIA/NIHSS=0, p=0.005). At 1 year, 37.9% of minor stroke patients had mRS≥2 (vs 13.4% TIA/NIHSS=0, p<0.0001) and 26.2% had at least moderate disability (vs 9.9% TIA/NIHSS=0, p<0.0001). 9.7% of minor stroke patients were dead at 1 year. Disability was more likely in patients with NIHSS scores of 3-4 compared to 1-2, at 90 days (46.3% vs. 23.4%, p=0.004) and 1 year (47.1% vs. 29.9%, p=0.03). Conclusions: In an unselected population-based cohort of TIA and ischaemic stroke patients nearly one third had NIHSS between 1-4 at presentation. Many, especially those with NIHSS scores of 3-4, had persistent stroke-related disability or were dead 1 year later. Routinely withholding thrombolytic therapy from such patients may represent a missed therapeutic opportunity.
Item Type:
Conference Presentation
Language:
en

Full metadata record

DC FieldValue Language
dc.contributor.authorMarnane, Men_GB
dc.contributor.authorCallaly, Een_GB
dc.contributor.authorHannon, Nen_GB
dc.contributor.authorMerwick, Aen_GB
dc.contributor.authorNi Chroinin, Den_GB
dc.contributor.authorSheehan, Oen_GB
dc.contributor.authorDuggan, Jen_GB
dc.contributor.authorMoroney, Jen_GB
dc.contributor.authorWilliams, Den_GB
dc.contributor.authorMcCormack, P M Een_GB
dc.contributor.authorMurphy, Sen_GB
dc.contributor.authorDolan, Een_GB
dc.contributor.authorO'Rourke, Ken_GB
dc.contributor.authorLynch, Ten_GB
dc.contributor.authorKelly, PJen_GB
dc.date.accessioned2012-08-28T15:10:54Z-
dc.date.available2012-08-28T15:10:54Z-
dc.date.issued2011-05-
dc.identifier.citationCerebrovascular Diseases (2011) 31 SUPPL. 2 (62). : May 2011en_GB
dc.identifier.urihttp://hdl.handle.net/10147/240273-
dc.description.abstractIntroduction: Current guidelines recommend caution when considering emergency tissue plasminogen activator (tPA) therapy for patients with minor neurological deficits. However few data exist regarding the “natural history” (without tPA) of stroke in unselected population-based cohorts. We sought to evaluate the risk of long term disability in “minor stroke” patients. Methods: In the 294,529 residents of North Dublin we prospectively identified all transient ischaemic attacks (TIAs) and ischaemic strokes over a 1 year period in 2005-06, immediately before a regional stroke thrombolysis service was begun. National Institutes of Health Stroke Scale (NIHSS) at presentation and functional status (modified Rankin Score, mRS) at 90 days and 1 year were assigned by trained investigators. Results: 478 patients were identified. 37.4% (179/478) had TIA or NIHSS=0 at presentation, 31.4% (150/478) had minor stroke (NIHSS=1-4), and 31.2% (149/478) had moderate/severe stroke (NIHSS=5-42). By 90 days, 34% of minor stroke patients had some disability (mRS≥2) (vs. 9.7% TIA/NIHSS=0, p<0.0001) and 16.7% had at least moderate disability (mRS≥3) (vs 6.4% TIA/NIHSS=0, p=0.005). At 1 year, 37.9% of minor stroke patients had mRS≥2 (vs 13.4% TIA/NIHSS=0, p<0.0001) and 26.2% had at least moderate disability (vs 9.9% TIA/NIHSS=0, p<0.0001). 9.7% of minor stroke patients were dead at 1 year. Disability was more likely in patients with NIHSS scores of 3-4 compared to 1-2, at 90 days (46.3% vs. 23.4%, p=0.004) and 1 year (47.1% vs. 29.9%, p=0.03). Conclusions: In an unselected population-based cohort of TIA and ischaemic stroke patients nearly one third had NIHSS between 1-4 at presentation. Many, especially those with NIHSS scores of 3-4, had persistent stroke-related disability or were dead 1 year later. Routinely withholding thrombolytic therapy from such patients may represent a missed therapeutic opportunity.en_GB
dc.language.isoenen
dc.publisherKargeren_GB
dc.titleNatural history of TPA-untreated minor stroke in the North Dublin population stroke studyen_GB
dc.typeConference Presentationen
dc.identifier.journalCerebrovascular Diseasesen_GB
dc.description.provinceLeinsteren
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