Influence of multiple long-term conditions on outcome after thrombolysis for acute ischemic stroke: secondary analysis of the ENCHANTED trial.

Background: The influence of multiple long-term conditions on the outcomes from acute ischemic stroke (AIS) are not well defined. This study aimed to determine the association of multiple long-term conditions in participants of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods: ENCHANTED was an international, multicenter, 2 x 2 quasi-factorial, open, randomised controlled, blinded endpoint assessed, trial that assessed the effectiveness and safety of intensive blood pressure lowering and low-dose thrombolysis against standard of care in adults with AIS. Multiple long-term condition was defined as two or more coexisting chronic conditions according to medical history. The primary outcome was function recovery (distribution of scores on the modified Rankin scale) and mortality at 90 days post-randomization. Associations were estimated in multivariate logistic regression models and an assessment of heterogeneity was undertaken in subgroups included age, sex, baseline systolic blood pressure, and clinical features.

Results: In 4,566 AIS participants (mean age 66.7 years, 37.8% female), those with multiple long-term conditions were older, more often female, and had more severe neurological impairment. Multiple long-term conditions increased the odds of poor functional outcome (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.03-1.30; p=0.020) and mortality (aOR 1.35, 95% CI 1.04-1.76; p=0.024). The association between multiple long-term conditions and mortality/functional outcome were consistent across all subgroups.

Conclusions: Individuals with multiple long-term conditions have higher odds of poor functional outcome and death after thrombolytic treatment for AIS.

Clinical Trial Registration: The trial is registered at ClinicalTrials.gov (NCT01422616) URL: clinicaltrials.gov/study/NCT01422616.