Unfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study

摘要

Summary Background Thrombolysis with alteplase is an effective and safe treatment for acute ischemic stroke ( AIS ). It is controversial whether the outcome of thrombolysis in cardioembolic stroke is different from that of other stroke subtypes. This study compares the outcomes at 3 months postthrombolysis in Chinese patients with AIS secondary to cardioembolism ( CE ) to the outcomes of those with large‐artery atherosclerosis ( LAA ). Methods Using the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China ( TIMS ‐China) cohort, we prospectively followed 827 patients treated within 4.5 h of onset symptoms with alteplase as an intravenous thrombolytic agent. CE and LAA were defined according to TOAST criteria. We compared symptomatic intracerebral hemorrhage ( SICH ), mortality, and functional outcome at 3 months using multivariables logistic regression analysis. Results In this cohort, 221 (19.6%) had CE and 606 (53.7%) had LAA . Approximately 2/3 of patients with CE had atrial fibrillation. Symptoms at onset were more severe in patients with CE than in those with LAA ( NIHSS , 15.0 vs. 11.0; P Conclusions Patients with cardioembolic stroke had more SICH after thrombolysis, and worse clinical outcome at 3‐month follow‐up compared with those with LAA . This emphasizes the importance of preventing cardioembolism.