The effect of modifiable stroke risk factors on systemic thrombolytic therapy in patients with acute stroke

Introduction. Systemic thrombolytic therapy (STT) is an effective and accessible method of reperfusion treatment for ischaemic stroke. However, it is not yet evident how the risk factors preceding ischaemic stroke affect disease progression and outcome, as well as the efficacy of STT.

The study aimed to examine the results of STT in stroke patients, depending on their risk factors, severity of those risk factors, and the success in managing them at the prehospital stage.

Materials and methods. We examined 229 patients who underwent SST, of whom 201 survived and 28 died. The presence of hypertension, type 2 diabetes mellitus, atrial fibrillation, or metabolic syndrome, as well as blood sugar level, lipid panel results, and body mass index were assessed.

Results. Ischaemic stroke subtype, the length of time from symptom onset to start of STT, or the presence of hypertension did not have a statistically significant effect on 28-day mortality. Patient age, NIHSS score, presence/absence of type 2 diabetes mellitus and atrial fibrillation, modified Rankin Scale score, blood sugar level, body mass index, and the presence of metabolic syndrome had a statistically significant influence on 28-day mortality. Data from the survived 201 patients were used to analyze the correlation between risk factors and functional recovery after ischaemic stroke. For patients with moderate and mild ischaemic stroke, statistically significant inverse correlations were found for age, blood sugar level, and body mass index.

Conclusion. An inverse correlation was found between 28-day mortality and age, severity of neurological impairment, blood sugar level at onset, body mass index, and the presence of the metabolic syndrome. The ‘obesity paradox’ was not identified in regard to survival, but patients with hypercholesterolemia had more significant regression of neurological symptoms and better functional recovery. Receiving statins and having a target cholesterol level were not found to have a positive effect on patient recovery in the first 28 days after disease onset, likely because of greater severity of the overall vascular disease.