Predictors of return to pre-stroke function after reperfusion therapy in patients with premorbid disability - a post-hoc analysis of the Czech Registry
| Authors | |
|---|---|
| Year of publication | 2025 |
| Type | Peer-reviewed scientific article |
| Magazine / Source | Ceska a slovenska neurologie a neurochirurgie |
| MU Faculty or unit | |
| Citation | |
| web | https://www.csnn.eu/en/journals/czech-and-slovak-neurology-and-neurosurgery/2025-6-10/predictors-of-return-to-pre-stroke-function-after-reperfusion-therapy-in-patients-with-premorbid-disability-a-post-hoc-analysis-of-the-czech-registry-142612 |
| Doi | https://doi.org/10.48095/cccsnn2025383 |
| Keywords | acute ischemic stroke; premorbid disability; reperfusion therapy; intravenous thrombolysis; endovascular treatment |
| Description | Background and objectives: The eligibility of acute ischemic stroke (AIS) patients with pre-existing neurological disability (modified Rankin Scale [mRS] >= 3) for acute reperfusion therapy remains uncertain. The aim was to identify factors predicting the return to their baseline functional status after reperfusion therapy in AIS patients with premorbid disability (pre-stroke mRS >= 3). Methods: We analyzed data from patients with premorbid disability from the Czech national registry for intravenous thrombolysis/endovascular treatment (2016-2020). The primary outcome was return to baseline mRS (Delta mRS = 0) at 3 months. Using multivariate logistic regression, we identified predictors of this outcome. Results: Among 1,712 patients, 32.1% (275/ 857) returned to their baseline status. Independent predictors of successful return included: age (adjusted odds ratio [aOR] 0.97 per year, 95% confidence interval [CI] 0.95-0.98), baseline National Institutes of Health Stroke Scale (NIHSS) (aOR 0.94 per point, 95% CI 0.92-0.96), absence of atrial fibrillation (aOR 0.78, 95% CI 0.63-0.97), and onset-to-treatment time (aOR 0.99 per minute, 95% CI 0.98-0.99). Patients with premorbid mRS 3 were more likely to return to baseline than those with an mRS 4-5 (aOR 1.42, 95% CI 1.18-1.67). Reperfusion was more effective in patients with atherothrombotic stroke etiology (aOR 1.69, 95% CI 1.31-2.14) compared to cardioembolic etiology (aOR 1.21, 95% CI 0.95-1.53). Discussion: Younger age, lower NIHSS, absence of atrial fibrillation, atherothrombotic etiology, and faster treatment commencement are key predictors of regaining baseline functional status after reperfusion in AIS patients with premorbid disability. |
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