Prognosis of Acute Cerebral Infarction Patients with Re-Occlusion After Alteplase Thrombolysis Therapy Treated by Tirofiban and Its Influencing Factors
Objective To investigate the prognosis of acute cerebral infarction(ACI)patients with re-occlusion after alteplase thrombolysis therapy treated by tirofiban,and to analyze the influencing factors of adverse prognosis.Methods A total of 154 ACI patients who received alteplase thrombolytic therapy and developed re-occlusion in the Guoyang County Hospital of Traditional Chinese Medicine from February 2021 to March 2022 were prospectively selected.All patients were treated with tirofiban.After one year of follow-up,the incidence of adverse prognosis such as intracranial hemorrhage,symptomatic intracranial hemorrhage,thrombocytopenia,fever,fatigue,and death during the follow-up period was recorded.Univariate analysis was conducted on the factors affecting the prognosis of ACI patients with re-occlusion after alteplase thrombolysis therapy treated by tirofiban.Multivariate Logistic regression analysis was used to screen for independent risk factors,in order to construct the risk prediction model.Receiver operating characteristic(ROC)curve was used to analyze the evaluation value of risk factors on prognosis.Results The incidence of adverse prognosis in 154 patients was 31.17%.The results of the univariate analysis showed that age,alcohol consumption history,infarct site,time from re-occlusion to treatment,infarct volume after re-occlusion,thrombolysis in cerebral infarction(TICI)grading,National Institute of Health Stroke Scale(NIHSS)score,combined coronary heart disease(CHD),and combined hypertension were significantly associated with adverse prognosis(P<0.05).The results of the multiple Logistic regression analysis showed that age(β=0.192,OR=1.212,P=0.005),alcohol consumption history(β=1.938,OR=6.946,P=0.007),NIHSS score(β=0.383,OR=1.467,P<0.001),time from re-occlusion to treatment(β=0.026,OR=1.026,P=0.010),infarct volume after re-occlusion(β=0.618,OR=1.855,P=0.003)and TICI grading(β=1.852,OR=6.371,P=0.012),combined CHD(β=2.226,OR=9.267,P=0.002),and combined hypertension(β=1.448,OR=4.255,P=0.041)were independent risk factors for adverse prognosis in ACI patients with re-occlusion after alteplase thrombolysis therapy.The results of ROC curve analysis showed that the area under the plasma concentration-time curve(AUC)was 0.923[95%CI(0.880,0.965),P<0.001],and the sensitivity and specificity corresponding to the optimal cut-off value of 0.351 were 0.938 and 0.849,respectively.Conclusion The adverse prognosis of ACI patients with re-occlusion after alteplase thrombolysis therapy treated by tirofiban is affected by many factors,and the established risk prediction model has good prognostic efficacy.
万方数据
维普
