Thrombolytic therapy for stroke in patients with preexisting cognitive impairment

Kei Murao; Didier Leys; Agnès Jacquin; Takanari Kitazono; Régis Bordet; Yannick Béjot; Kazumi Kimura; Olivier Godefroy; Yoshinobu Wakisaka; Solène Moulin; Tetsuro Ago; Igor Sibon; Stéphanie Bombois; Jean-Louis Mas; Hilde Hénon; Florence Pasquier; Maurice Giroud; Charlotte Cordonnier; Yasushi Okada; OPHELIE-COG investigators

doi:10.1212/WNL.0000000000000493

Thrombolytic therapy for stroke in patients with preexisting cognitive impairment

Neurology. 2014 Jun 10;82(23):2048-54. doi: 10.1212/WNL.0000000000000493. Epub 2014 May 14.

Authors

Kei Murao¹, Didier Leys², Agnès Jacquin¹, Takanari Kitazono¹, Régis Bordet¹, Yannick Béjot¹, Kazumi Kimura¹, Olivier Godefroy¹, Yoshinobu Wakisaka¹, Solène Moulin¹, Tetsuro Ago¹, Igor Sibon¹, Stéphanie Bombois¹, Jean-Louis Mas¹, Hilde Hénon¹, Florence Pasquier¹, Maurice Giroud¹, Charlotte Cordonnier¹, Yasushi Okada¹; OPHELIE-COG investigators

Affiliations

¹ From the University Lille North of France (K.M., D.L., R.B., S.M., S.B., H.H., F.P., C.C.), UDSL (EA 1046); the Department of Cerebrovascular Medicine and Neurology (K.M., Y.W., Y.O.), Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; Stroke Center (D.L., S.M., H.H., C.C.), Pharmacological Department (R.B.), and Lille Center Mémoire de Ressources et de Recherché (S.B., F.P.), Lille University Hospital; Dijon Stroke Registry (A.J., Y.B., M.G.), EA3173 (Inserm and InVS), IFR 90 (STIC-Santé), Faculty of Medicine, University of Burgundy and University Hospital of Dijon, Dijon Center Mémoire de Ressources et de Recherche, University Hospital of Dijon, France; the Department of Medicine and Clinical Science (T.K., Y.W., T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; the Department of Stroke Medicine (K.K.), Kawasaki Medical School, Kurashiki, Japan; the Department of Neurology (O.G.), Amiens University Hospital; Stroke Department (I.S.), University of Bordeaux; the Department of Neurology (J.-L.M.), Stroke Center, Sainte-Anne Hospital, University Paris Descartes, Sorbonne Paris Cité, INSERM UMR S783, Paris; and the Strokavenir Network (K.M., D.L., A.J., T.K., R.B., Y.B., O.G., S.M., I.S., J.-L.M., H.H., M.G., C.C.), Lille, France.
² From the University Lille North of France (K.M., D.L., R.B., S.M., S.B., H.H., F.P., C.C.), UDSL (EA 1046); the Department of Cerebrovascular Medicine and Neurology (K.M., Y.W., Y.O.), Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; Stroke Center (D.L., S.M., H.H., C.C.), Pharmacological Department (R.B.), and Lille Center Mémoire de Ressources et de Recherché (S.B., F.P.), Lille University Hospital; Dijon Stroke Registry (A.J., Y.B., M.G.), EA3173 (Inserm and InVS), IFR 90 (STIC-Santé), Faculty of Medicine, University of Burgundy and University Hospital of Dijon, Dijon Center Mémoire de Ressources et de Recherche, University Hospital of Dijon, France; the Department of Medicine and Clinical Science (T.K., Y.W., T.A.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; the Department of Stroke Medicine (K.K.), Kawasaki Medical School, Kurashiki, Japan; the Department of Neurology (O.G.), Amiens University Hospital; Stroke Department (I.S.), University of Bordeaux; the Department of Neurology (J.-L.M.), Stroke Center, Sainte-Anne Hospital, University Paris Descartes, Sorbonne Paris Cité, INSERM UMR S783, Paris; and the Strokavenir Network (K.M., D.L., A.J., T.K., R.B., Y.B., O.G., S.M., I.S., J.-L.M., H.H., M.G., C.C.), Lille, France. didier.leys@chru-lille.fr.

PMID: 24827495
DOI: 10.1212/WNL.0000000000000493

Abstract

Objective: We aimed to evaluate the influence of prestroke cognitive impairment (PSCI) on outcomes in stroke patients treated with IV recombinant tissue plasminogen activator (rtPA).

Methods: OPHELIE-COG was a prospective observational multicenter study conducted in French and Japanese patients treated with IV rtPA for cerebral ischemia. The preexisting cognitive status was evaluated by the short version of the Informant Questionnaire on Cognitive Decline in the Elderly. PSCI was defined as a mean score >3. The primary endpoint was a favorable outcome (modified Rankin Scale [mRS] score 0-1) after 3 months. Secondary endpoints were symptomatic intracerebral hemorrhage (sICH), mRS scores 0-2, and mortality at 3 months. We performed a pooled analysis with Biostroke and Strokdem.

Results: Of 205 patients, 62 (30.2%) met criteria for PSCI. They were 11 years older (p < 0.001). Although they had more sICH and were less frequently independent after 3 months, they did not differ for any endpoint after adjustment for age, baseline NIH Stroke Scale score, and onset-to-needle time: sICH (odds ratio [OR] 2.78; 95% confidence interval [CI] 0.65-11.86), mRS 0-1 (OR 0.82; 95% CI 0.41-1.65), mRS 0-2 (OR 0.62; 95% CI 0.28-1.37), death (OR 0.40; 95% CI 0.08-2.03). The pooled analysis found no association of PSCI with any endpoint.

Conclusions: Ischemic stroke patients with PSCI should receive rtPA if they are eligible. This conclusion cannot be extended to severe cognitive impairment or severe strokes.

Classification of evidence: This study provides Class IV evidence that in patients with PSCI presenting with acute ischemic stroke, IV rtPA improves outcomes.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Brain Ischemia / complications
Brain Ischemia / drug therapy*
Brain Ischemia / epidemiology
Brain Ischemia / mortality
Cerebral Hemorrhage / epidemiology
Cerebral Hemorrhage / etiology
Cognition Disorders / epidemiology*
Female
Fibrinolytic Agents / therapeutic use*
Humans
Male
Middle Aged
Prospective Studies
Stroke / complications
Stroke / drug therapy*
Stroke / epidemiology
Stroke / mortality
Thrombolytic Therapy / standards*
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator