[P02.083] Clinical Outcomes of Patients with Congestive Heart Failure Who Receive Thrombolytic Therapy for Acute Ischemic Stroke
Kachikwu Illoh, Miriam Morales, Tamara Humphrey, Alexander Katcheves, Nneka Ifejika, Francisco Fuentes, Mc Lean, VA, Houston, TX
OBJECTIVE: To determine whether thrombolytic therapy improved outcome among patients with CHF presenting with AIS. BACKGROUND: Patients with severe congestive heart failure (CHF) often have impaired cerebral perfusion. They have poor clinical outcomes on presenting with acute ischemic stroke (AIS). In these patients, it is likely that prompt thrombolysis would stem further decline in an already compromised cerebral perfusion state. Whether thrombolytic therapy improves the outcome in these patients is unclear. DESIGN/METHODS: In a cohort study with retrospective review of records from a prospectively collected database, we included AIS patients who were consecutively admitted to the stroke service of a large tertiary care center. Poor clinical outcome was defined as a modified Rankin score (mRS) of greater than 3. We examined the characteristics of AIS patients with history of CHF by their thrombolytic therapy status and compared their clinical outcomes with non-CHF patients. RESULTS: A total of 2,180 AIS patients with a mean age of 65 (SD, 15) years and 53% females were enrolled. Of the entire cohort, 26% (576/2180) received intravenous thrombolytic therapy, and 9% (196/2180) had history of CHF. The in-hospital mortality overall was 6% (129/2081); among CHF patients mortality was 8%. Of the 196 CHF patients, 66 (34%) got thrombolytic therapy. Yet, the CHF patients who received thrombolytic therapy did not achieve better mortality outcome compared to those not receiving the treatment (9% versus 8%, P = 0.786). Likewise, there was no difference in functional outcome between CHF patients who got thrombolytic therapy and CHF patients without the treatment (mRS >3; 49% versus 50%; P = 1.000). CONCLUSIONS/RELEVANCE: In patients with history of CHF who presented with AIS, thrombolytic therapy was not associated with an improvement in their clinical outcome. This finding needs further exploration in larger studies as more aggressive management of CHF may be required to augment thro mbolytic therapy.
Category - Cerebrovascular Disease - Acute Stroke Therapy
Tuesday, April 28, 2009 11:30 AM
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