The effect of alteplase within 6 hours of acute ischemic stroke on all-cause mortality (3rd International Stroke Trial)
Identifieur interne : 003441 ( Main/Exploration ); précédent : 003440; suivant : 003442The effect of alteplase within 6 hours of acute ischemic stroke on all-cause mortality (3rd International Stroke Trial)
Auteurs : William N. Whiteley [Royaume-Uni] ; Douglas Thompson [Royaume-Uni] ; Gordon Murray [Royaume-Uni] ; Geoff Cohen [Royaume-Uni] ; Richard I. Lindley [Australie] ; Joanna Wardlaw [Royaume-Uni] ; Peter Sandercock [Royaume-Uni]Source :
- Stroke; a journal of cerebral circulation [ 0039-2499 ] ; 2014.
Abstract
Prompt thrombolytic therapy with intravenous alteplase reduces disability after acute ischemic stroke. In an exploratory analysis we examined whether long-term survival varied by baseline characteristics after alteplase.
In this open-treatment, international, randomized, controlled trial, ischemic stroke patients were randomly allocated <6h of onset to intravenous alteplase (0·9 mg/kg) plus standard care (n=1515) or standard care alone (n=1520). We followed patients to death, censoring when last known to be alive. We grouped patients by delay to randomization, and ‘good’ or ‘poor’ predicted prognosis (calculated from baseline NIHS score and age). We present absolute mortality differences between treated and control groups at 7 days, 6 months and 18 months post stroke.
Alteplase was not associated with a significant increase in mortality within 18 months [0.6% (95%CI:−2.9% to +4.2) P=0.72] in all patients with complete vital status (99.9%, 3034/3035). In patients randomized <3 hrs of stroke, 18 month mortality was lower in the alteplase treated group than the control group [40.6%(95%CI:42.6–52.7) vs 47.8%(95%CI:35.5–45.3)
These exploratory analyses of the IST-3 trial support improving acute stroke patients’ access to earlier alteplase treatment; treatment of patients with poor prognosis; and further randomized controlled trials in minor stroke to replicate these findings.
Url:
DOI: 10.1161/STROKEAHA.114.006890
PubMed: 25370587
PubMed Central: 4282176
Affiliations:
- Australie, Royaume-Uni
- Nouvelle-Galles du Sud, Écosse
- Sydney, Édimbourg
- Université d'Édimbourg, Université de Sydney
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Le document en format XML
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>BACKGROUND & PURPOSE</title>
<p id="P1">Prompt thrombolytic therapy with intravenous alteplase reduces disability after acute ischemic stroke. In an exploratory analysis we examined whether long-term survival varied by baseline characteristics after alteplase.</p>
</sec>
<sec id="S2"><title>METHODS</title>
<p id="P2">In this open-treatment, international, randomized, controlled trial, ischemic stroke patients were randomly allocated <6h of onset to intravenous alteplase (0·9 mg/kg) plus standard care (n=1515) or standard care alone (n=1520). We followed patients to death, censoring when last known to be alive. We grouped patients by delay to randomization, and ‘good’ or ‘poor’ predicted prognosis (calculated from baseline NIHS score and age). We present absolute mortality differences between treated and control groups at 7 days, 6 months and 18 months post stroke.</p>
</sec>
<sec id="S3"><title>RESULTS</title>
<p id="P3">Alteplase was not associated with a significant increase in mortality within 18 months [0.6% (95%CI:−2.9% to +4.2) P=0.72] in all patients with complete vital status (99.9%, 3034/3035). In patients randomized <3 hrs of stroke, 18 month mortality was lower in the alteplase treated group than the control group [40.6%(95%CI:42.6–52.7) vs 47.8%(95%CI:35.5–45.3)<italic>P</italic>
=0.0434].The difference in 18 month mortality between alteplase-treated and control patients was greater in patients who were randomized early (<3h) compared to late (3-6h) [+9%(95%CI:1–17)P=0.0317]. Alteplase led to a greater improvement in 18 month survival in patients with a poor prognosis than in patients with a good prognosis [+8% (95%CI: 2–14)P=0.0091].</p>
</sec>
<sec id="S4"><title>CONCLUSIONS</title>
<p id="P4">These exploratory analyses of the IST-3 trial support improving acute stroke patients’ access to earlier alteplase treatment; treatment of patients with poor prognosis; and further randomized controlled trials in minor stroke to replicate these findings.</p>
</sec>
<sec id="S5"><title>CLINICAL TRIAL REGISTRATION</title>
<p id="P5"><ext-link ext-link-type="uri" xlink:href="http://www.controlled-trials.com">www.controlled-trials.com</ext-link>
. Unique identifier: ISRCTN25765518</p>
</sec>
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<country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Lindley, Richard I" sort="Lindley, Richard I" uniqKey="Lindley R" first="Richard I." last="Lindley">Richard I. Lindley</name>
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