Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke

Nishant K. Mishra, Pitchaiah Mandava, Christopher Chen, James Grotta, Kennedy R. Lees, Thomas A. Kent, A. Alexandrov, P. W. Bath, E. Bluhmki, L. Claesson, J. Curram, S. M. Davis, G. Donnan, H. C. Diener, M. Fisher, B. Gregson, J. Grotta, W. Hacke, M. G. Hennerici, M. Hommel & 11 others M. Kaste, K. R. Lees, P. Lyden, J. Marler, K. Muir, R. Sacco, A. Shuaib, P. Teal, N. G. Wahlgren, S. Warach, C. Weimar

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The National Institutes of Neurological Disorders and Stroke and the European Co-operative Acute Stroke III trials enrolled a largely Caucasian population, but the results are often extrapolated onto non-Caucasians. A limited number of nonrandomized studies have proposed that non-Caucasian patients show differential response to tissue plasminogen activator. Aims and/or hypothesis: We examined if non-Caucasian patients of mixed national origin within the Virtual International Stroke Trials Archives neuroprotection trials responded differently to tissue plasminogen activator compared with Caucasians. Methods: We matched patients within each race-subtype for age, baseline National Institutes of Health Stroke Scales, and diabetes status, and excluded outliers. We tested for an interaction of race ethnicity with tissue plasminogen activator on predicting outcomes at α=0·05. We compared 90-day ordinal outcome (modified Rankin Scale; primary analysis) and dichotomized outcomes (modified Rankin Scale 0-1; modified Rankin Scale 0-2; survival) within individual race ethnicity. Results: One thousand nine hundred forty-six thrombolysed patients (125 Blacks, 39 Asians, and 1821 Caucasians) were matched with 1946 non-thrombolysed patients in each race ethnicity group. Postmatching, there were no imbalances in baseline National Institutes of Health Stroke Scales and age between the groups (P>0·05). The interaction of tissue plasminogen activator with race ethnicity was nonsignificant in ordinal (P=0·4) and in dichotomized outcome models (P>0·05). Ordinal odds for improved outcomes were 1·5 for all patients (P<0·05). Ordinal odds for Caucasians were 1·5 (P<0·05); for Blacks, 2·1 (P<0·05); and for Asians, 1·2 (P>0·05; 1·6 after 1:2 matching with nonthrombolysed, because of small numbers). Dichotomized functional outcomes improved after thrombolysis overall, in Caucasians, in Blacks (modified Rankin Scale 0-2 only), and in Asians (after 1:2 matching; P>0·05). Odds for survival were consistent across all groups. Conclusions: These results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.

Original languageEnglish (US)
Pages (from-to)613-617
Number of pages5
JournalInternational Journal of Stroke
Volume9
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Thrombolytic Therapy
Tissue Plasminogen Activator
Stroke
National Institutes of Health (U.S.)
National Institute of Neurological Disorders and Stroke
Survival
Age Groups
Population

Keywords

  • African American/Black
  • Asian
  • Caucasian
  • Clinical trials
  • Race ethnicity
  • TPA

ASJC Scopus subject areas

  • Neurology
  • Medicine(all)

Cite this

Mishra, N. K., Mandava, P., Chen, C., Grotta, J., Lees, K. R., Kent, T. A., ... Weimar, C. (2014). Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke. International Journal of Stroke, 9(5), 613-617. https://doi.org/10.1111/ijs.12162

Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke. / Mishra, Nishant K.; Mandava, Pitchaiah; Chen, Christopher; Grotta, James; Lees, Kennedy R.; Kent, Thomas A.; Alexandrov, A.; Bath, P. W.; Bluhmki, E.; Claesson, L.; Curram, J.; Davis, S. M.; Donnan, G.; Diener, H. C.; Fisher, M.; Gregson, B.; Grotta, J.; Hacke, W.; Hennerici, M. G.; Hommel, M.; Kaste, M.; Lees, K. R.; Lyden, P.; Marler, J.; Muir, K.; Sacco, R.; Shuaib, A.; Teal, P.; Wahlgren, N. G.; Warach, S.; Weimar, C.

In: International Journal of Stroke, Vol. 9, No. 5, 2014, p. 613-617.

Research output: Contribution to journalArticle

Mishra, NK, Mandava, P, Chen, C, Grotta, J, Lees, KR, Kent, TA, Alexandrov, A, Bath, PW, Bluhmki, E, Claesson, L, Curram, J, Davis, SM, Donnan, G, Diener, HC, Fisher, M, Gregson, B, Grotta, J, Hacke, W, Hennerici, MG, Hommel, M, Kaste, M, Lees, KR, Lyden, P, Marler, J, Muir, K, Sacco, R, Shuaib, A, Teal, P, Wahlgren, NG, Warach, S & Weimar, C 2014, 'Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke', International Journal of Stroke, vol. 9, no. 5, pp. 613-617. https://doi.org/10.1111/ijs.12162
Mishra, Nishant K. ; Mandava, Pitchaiah ; Chen, Christopher ; Grotta, James ; Lees, Kennedy R. ; Kent, Thomas A. ; Alexandrov, A. ; Bath, P. W. ; Bluhmki, E. ; Claesson, L. ; Curram, J. ; Davis, S. M. ; Donnan, G. ; Diener, H. C. ; Fisher, M. ; Gregson, B. ; Grotta, J. ; Hacke, W. ; Hennerici, M. G. ; Hommel, M. ; Kaste, M. ; Lees, K. R. ; Lyden, P. ; Marler, J. ; Muir, K. ; Sacco, R. ; Shuaib, A. ; Teal, P. ; Wahlgren, N. G. ; Warach, S. ; Weimar, C. / Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke. In: International Journal of Stroke. 2014 ; Vol. 9, No. 5. pp. 613-617.
@article{dbcd3955c504457896a00728e4d6dee8,
title = "Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke",
abstract = "Background: The National Institutes of Neurological Disorders and Stroke and the European Co-operative Acute Stroke III trials enrolled a largely Caucasian population, but the results are often extrapolated onto non-Caucasians. A limited number of nonrandomized studies have proposed that non-Caucasian patients show differential response to tissue plasminogen activator. Aims and/or hypothesis: We examined if non-Caucasian patients of mixed national origin within the Virtual International Stroke Trials Archives neuroprotection trials responded differently to tissue plasminogen activator compared with Caucasians. Methods: We matched patients within each race-subtype for age, baseline National Institutes of Health Stroke Scales, and diabetes status, and excluded outliers. We tested for an interaction of race ethnicity with tissue plasminogen activator on predicting outcomes at α=0·05. We compared 90-day ordinal outcome (modified Rankin Scale; primary analysis) and dichotomized outcomes (modified Rankin Scale 0-1; modified Rankin Scale 0-2; survival) within individual race ethnicity. Results: One thousand nine hundred forty-six thrombolysed patients (125 Blacks, 39 Asians, and 1821 Caucasians) were matched with 1946 non-thrombolysed patients in each race ethnicity group. Postmatching, there were no imbalances in baseline National Institutes of Health Stroke Scales and age between the groups (P>0·05). The interaction of tissue plasminogen activator with race ethnicity was nonsignificant in ordinal (P=0·4) and in dichotomized outcome models (P>0·05). Ordinal odds for improved outcomes were 1·5 for all patients (P<0·05). Ordinal odds for Caucasians were 1·5 (P<0·05); for Blacks, 2·1 (P<0·05); and for Asians, 1·2 (P>0·05; 1·6 after 1:2 matching with nonthrombolysed, because of small numbers). Dichotomized functional outcomes improved after thrombolysis overall, in Caucasians, in Blacks (modified Rankin Scale 0-2 only), and in Asians (after 1:2 matching; P>0·05). Odds for survival were consistent across all groups. Conclusions: These results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.",
keywords = "African American/Black, Asian, Caucasian, Clinical trials, Race ethnicity, TPA",
author = "Mishra, {Nishant K.} and Pitchaiah Mandava and Christopher Chen and James Grotta and Lees, {Kennedy R.} and Kent, {Thomas A.} and A. Alexandrov and Bath, {P. W.} and E. Bluhmki and L. Claesson and J. Curram and Davis, {S. M.} and G. Donnan and Diener, {H. C.} and M. Fisher and B. Gregson and J. Grotta and W. Hacke and Hennerici, {M. G.} and M. Hommel and M. Kaste and Lees, {K. R.} and P. Lyden and J. Marler and K. Muir and R. Sacco and A. Shuaib and P. Teal and Wahlgren, {N. G.} and S. Warach and C. Weimar",
year = "2014",
doi = "10.1111/ijs.12162",
language = "English (US)",
volume = "9",
pages = "613--617",
journal = "International Journal of Stroke",
issn = "1747-4930",
publisher = "Wiley-Blackwell",
number = "5",

}

TY - JOUR

T1 - Influence of racial differences on outcomes after thrombolytic therapy in acute ischemic stroke

AU - Mishra, Nishant K.

AU - Mandava, Pitchaiah

AU - Chen, Christopher

AU - Grotta, James

AU - Lees, Kennedy R.

AU - Kent, Thomas A.

AU - Alexandrov, A.

AU - Bath, P. W.

AU - Bluhmki, E.

AU - Claesson, L.

AU - Curram, J.

AU - Davis, S. M.

AU - Donnan, G.

AU - Diener, H. C.

AU - Fisher, M.

AU - Gregson, B.

AU - Grotta, J.

AU - Hacke, W.

AU - Hennerici, M. G.

AU - Hommel, M.

AU - Kaste, M.

AU - Lees, K. R.

AU - Lyden, P.

AU - Marler, J.

AU - Muir, K.

AU - Sacco, R.

AU - Shuaib, A.

AU - Teal, P.

AU - Wahlgren, N. G.

AU - Warach, S.

AU - Weimar, C.

PY - 2014

Y1 - 2014

N2 - Background: The National Institutes of Neurological Disorders and Stroke and the European Co-operative Acute Stroke III trials enrolled a largely Caucasian population, but the results are often extrapolated onto non-Caucasians. A limited number of nonrandomized studies have proposed that non-Caucasian patients show differential response to tissue plasminogen activator. Aims and/or hypothesis: We examined if non-Caucasian patients of mixed national origin within the Virtual International Stroke Trials Archives neuroprotection trials responded differently to tissue plasminogen activator compared with Caucasians. Methods: We matched patients within each race-subtype for age, baseline National Institutes of Health Stroke Scales, and diabetes status, and excluded outliers. We tested for an interaction of race ethnicity with tissue plasminogen activator on predicting outcomes at α=0·05. We compared 90-day ordinal outcome (modified Rankin Scale; primary analysis) and dichotomized outcomes (modified Rankin Scale 0-1; modified Rankin Scale 0-2; survival) within individual race ethnicity. Results: One thousand nine hundred forty-six thrombolysed patients (125 Blacks, 39 Asians, and 1821 Caucasians) were matched with 1946 non-thrombolysed patients in each race ethnicity group. Postmatching, there were no imbalances in baseline National Institutes of Health Stroke Scales and age between the groups (P>0·05). The interaction of tissue plasminogen activator with race ethnicity was nonsignificant in ordinal (P=0·4) and in dichotomized outcome models (P>0·05). Ordinal odds for improved outcomes were 1·5 for all patients (P<0·05). Ordinal odds for Caucasians were 1·5 (P<0·05); for Blacks, 2·1 (P<0·05); and for Asians, 1·2 (P>0·05; 1·6 after 1:2 matching with nonthrombolysed, because of small numbers). Dichotomized functional outcomes improved after thrombolysis overall, in Caucasians, in Blacks (modified Rankin Scale 0-2 only), and in Asians (after 1:2 matching; P>0·05). Odds for survival were consistent across all groups. Conclusions: These results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.

AB - Background: The National Institutes of Neurological Disorders and Stroke and the European Co-operative Acute Stroke III trials enrolled a largely Caucasian population, but the results are often extrapolated onto non-Caucasians. A limited number of nonrandomized studies have proposed that non-Caucasian patients show differential response to tissue plasminogen activator. Aims and/or hypothesis: We examined if non-Caucasian patients of mixed national origin within the Virtual International Stroke Trials Archives neuroprotection trials responded differently to tissue plasminogen activator compared with Caucasians. Methods: We matched patients within each race-subtype for age, baseline National Institutes of Health Stroke Scales, and diabetes status, and excluded outliers. We tested for an interaction of race ethnicity with tissue plasminogen activator on predicting outcomes at α=0·05. We compared 90-day ordinal outcome (modified Rankin Scale; primary analysis) and dichotomized outcomes (modified Rankin Scale 0-1; modified Rankin Scale 0-2; survival) within individual race ethnicity. Results: One thousand nine hundred forty-six thrombolysed patients (125 Blacks, 39 Asians, and 1821 Caucasians) were matched with 1946 non-thrombolysed patients in each race ethnicity group. Postmatching, there were no imbalances in baseline National Institutes of Health Stroke Scales and age between the groups (P>0·05). The interaction of tissue plasminogen activator with race ethnicity was nonsignificant in ordinal (P=0·4) and in dichotomized outcome models (P>0·05). Ordinal odds for improved outcomes were 1·5 for all patients (P<0·05). Ordinal odds for Caucasians were 1·5 (P<0·05); for Blacks, 2·1 (P<0·05); and for Asians, 1·2 (P>0·05; 1·6 after 1:2 matching with nonthrombolysed, because of small numbers). Dichotomized functional outcomes improved after thrombolysis overall, in Caucasians, in Blacks (modified Rankin Scale 0-2 only), and in Asians (after 1:2 matching; P>0·05). Odds for survival were consistent across all groups. Conclusions: These results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.

KW - African American/Black

KW - Asian

KW - Caucasian

KW - Clinical trials

KW - Race ethnicity

KW - TPA

UR - http://www.scopus.com/inward/record.url?scp=84902104795&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902104795&partnerID=8YFLogxK

U2 - 10.1111/ijs.12162

DO - 10.1111/ijs.12162

M3 - Article

VL - 9

SP - 613

EP - 617

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 5

ER -