Predictors of return to pre-stroke function after reperfusion therapy in patients with premorbid disability – a post-hoc analysis of the Czech Registry

Czech version

Authors: I. Szegedi ^1-3; A. Ganesh ⁴; A. Tomek ⁵; M. Bar ^1,6; R. Pádr ⁷; F. Cihlář ⁸; S. Ostrý ^9,10; L. Kočí ¹¹; M. Kovář ¹²; P. Ševčík ¹³; V. Rohan ¹³; M. Slovák ¹⁴; D. Černík ^15,16; R. Jura ¹⁷; D. Václavík ¹⁸; M. D. Hill ^4,19; R. Mikulík ^20,21; O. Volný ^1,6
Authors‘ workplace: Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic ¹; Department of Neurology, University of Debrecen, Debrecen, Hungary ²; Lendület “Momentum” Hemostasis and Stroke Research Group of the Hungarian Academy of Sciences, Debrecen, Hungary ³; Calgary Stroke Program, Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute, and the O’Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada ⁴; Department of Neurology, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic ⁵; Center of Clinical Neurosciences, Faculty of Medicine, University Ostrava, Ostrava, Czech Republic ⁶; Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Czech Republic ⁷; Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic ⁸; Department of Neurology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic ⁹; Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University in Prague and Military University Hospital Prague, Czech Republic ¹⁰; Neurocenter, Regional Hospital Liberec, Liberec, Czech Republic ¹¹; Department of Neurology, Na Homolce Hospital, Prague, Czech Republic ¹²; Department of Neurology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic ¹³; Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic ¹⁴; Comprehensive stroke center, Department of Neurology, Masaryk Hospital, Krajska zdravotni as, Ustí nad Labem, Czech Republic ¹⁵; Comprehensive Stroke Center, Department of Neurology, Palacky University Medical School and University Hospital Olomouc, Czech Republic ¹⁶; Department of Neurology, University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic ¹⁷; Department of Neurology, AGEL Research and Training Institute, Ostrava Vitkovice Hospital, Ostrava, Czech Republic ¹⁸; Departments of Radiology and Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada ¹⁹; International Clinical Research Centre, Stroke Research Program, St. Anne’s University Hospital, Brno, Czech Republic ²⁰; Neurology Department, Tomas Bata Regional Hospital, Zlin, Czech Republic ²¹
Published in: Cesk Slov Neurol N 2025; 88(6): 383-387
Category: Letter to Editor
doi: https://doi.org/10.48095/cccsnn2025383

Overview

Background and objectives: The eligibility of acute ischemic stroke (AIS) patients with pre-existing neurological disability (modified Rankin Scale [mRS] ≥ 3) for acute reperfusion therapy remains uncertain. The aim was to identify factors predicting the return to their baseline functional status after reperfusion therapy in AIS patients with premorbid disability (pre-stroke mRS ≥ 3). Methods: We analyzed data from patients with premorbid disability from the Czech national registry for intravenous thrombolysis/endovascular treatment (2016–2020). The primary outcome was return to baseline mRS (DmRS = 0) at 3 months. Using multivariate logistic regression, we identified predictors of this outcome. Results: Among 1,712 patients, 32.1% (275/857) returned to their baseline status. Independent predictors of successful return included: age (adjusted odds ratio [aOR] 0.97 per year, 95% confidence interval [CI] 0.95–0.98), baseline National Institutes of Health Stroke Scale (NIHSS) (aOR 0.94 per point, 95% CI 0.92–0.96), absence of atrial fibrillation (aOR 0.78, 95% CI 0.63–0.97), and onset-to-treatment time (aOR 0.99 per minute, 95% CI 0.98–0.99). Patients with premorbid mRS 3 were more likely to return to baseline than those with an mRS 4–5 (aOR 1.42, 95% CI 1.18–1.67). Reperfusion was more effective in patients with atherothrombotic stroke etiology (aOR 1.69, 95% CI 1.31–2.14) compared to cardioembolic etiology (aOR 1.21, 95% CI 0.95–1.53). Discussion: Younger age, lower NIHSS, absence of atrial fibrillation, atherothrombotic etiology, and faster treatment commencement are key predictors of regaining baseline functional status after reperfusion in AIS patients with premorbid disability.

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Czech and Slovak Neurology and Neurosurgery

2025 Issue 6

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