Therapeutics and Clinical Risk Management (Jun 2016)

The Oxfordshire Community Stroke Project classification system predicts clinical outcomes following intravenous thrombolysis: a prospective cohort study

  • Yang Y,
  • Wang A,
  • Zhao X,
  • Wang C,
  • Liu L,
  • Zheng H,
  • Wang Y,
  • Cao Y,
  • Wang Y

Journal volume & issue
Vol. 2016, no. Issue 1
pp. 1049 – 1056

Abstract

Read online

Yuling Yang,1,* Anxin Wang,2–6,* Xingquan Zhao,2–5 Chunxue Wang,2–5 Liping Liu,2–5 Huaguang Zheng,2–5 Yongjun Wang,2–5 Yibin Cao,7 Yilong Wang2–5 On behalf of the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China (TIMS-China) investigators 1Graduate School, North China University of Science and Technology, Tangshan, 2Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 3China National Clinical Research Center for Neurological Diseases, 4Center of Stroke, Beijing Institute for Brain Disorders, 5Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, 6Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, 7Department of Neurology, Tangshan Gongren Hospital, Tangshan, People’s Republic of China *These authors contributed equally to this work Background: The Oxfordshire Community Stroke Project (OCSP) classification system is a simple stroke classification system that can be used to predict clinical outcomes. In this study, we compare the safety and efficacy of intravenous thrombolysis in Chinese stroke patients categorized using the OCSP classification system. Patients and methods: We collected data from the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China registry. A total of 1,115 patients treated with intravenous thrombolysis with alteplase within 4.5 hours of stroke onset were included. Symptomatic intracranial hemorrhage (SICH), mortality, and 90-day functional outcomes were compared between the stroke patients with different stroke subtypes. Results: Of the 1,115 patients included in the cohort, 197 (17.67%) were classified with total anterior circulation infarct (TACI), 700 (62.78%) with partial anterior circulation infarct, 153 (13.72%) with posterior circulation infarct, and 65 (5.83%) with lacunar infarct. After multivariable adjustment, compared to the patients with non-TACI, those with TACI had a significantly increased risk of SICH (odds ratio [OR] 8.80; 95% confidence interval [CI] 2.84–27.25, P<0.001), higher mortality (OR 5.24; 95% CI 3.19–8.62; P<0.001), and poor functional independence (OR 0.38; 95% CI 0.26–0.56; P<0.001) at 3-month follow-up. Conclusion: After thrombolysis, the patients with TACI exhibited greater SICH, a higher mortality rate, and worse 3-month clinical outcomes compared with the patients with non-TACI. The OCSP classification system may help clinicians predict the safety and efficacy of thrombolysis. Keywords: acute ischemic stroke, intravenous thrombolysis, OCSP classification, outcome, symptomatic intracranial hemorrhage

Keywords