Background and Purpose: The present study aimed to devise a simple scale to predict very poor outcome after tissue plasminogen activator (t-PA) therapy using clinical and MRI factors. Methods: Consecutive stroke patients treated with t-PA within 3 h of onset were studied prospectively. Clinical factors and MRI findings independently associated with very poor outcome (modified Rankin Scale score 4–6) at 3 months after t-PA therapy were assessed. Results: The subjects were 117 patients. Multivariate logistic regression analysis revealed the following independent factors associated with very poor outcome: time from stroke onset to treatment ≧140 min (OR 2.790, 95% CI 1.082–7.193; p = 0.0337), baseline National Institutes of Health Stroke Scale score ≧20 (OR 3.794, 95% CI 1.199–12.009; p = 0.0233), glucose ≧180 mg/dl (OR 3.288, 95% CI 1.126–9.600; p = 0.0295), internal carotid artery occlusion (OR 6.187, 95% CI 5.090–18.354; p = 0.0129) and M1 susceptibility vessel sign (OR 6.379, 95% CI 1.194–34.074; p = 0.030). Those 5 variables were selected in the scale, with each factor as 1 point. Frequencies of patients with a very poor outcome for each score were as follows: score 0, 26.3%; score 1, 30.6%; score 2, 70.0%, and score 3–5, 100%. Conclusion: A clinical scale using clinical and MRI factors can predict very poor outcome in t-PA patients.

Keywords:
Tissue plasminogen activator, Patient outcome, MRI scale
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2011
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