2023
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial
Wang Y, Li S, Pan Y, Li H, Parsons M, Campbell B, Schwamm L, Fisher M, Che F, Dai H, Li D, Li R, Wang J, Wang Y, Zhao X, Li Z, Zheng H, Xiong Y, Meng X, Investigators T, Li R, Wang D, Wang Y, Chen S, Deng D, Zhang H, Wang J, Chen H, Zhang H, Wu Y, Liu H, Lu G, Zhao L, Zhu R, Liu Y, Yi F, Gao J, Dai H, Hao J, Che F, Cai X, Duan Z, Yu H, Wei T, Tang Y, Peng Z, Zhang B, Song Y, Chen X, Liu Y, Liu J, Li D, Zhao W, Wei X, Xue Q, Liu X, Yang Y, zhao C, Chen J, Sui Y, Sheng G, Zhang Y, Liu J, Zhang L, Wang W, Guo Z, Li H, Hu R, Chen G, Liang Z, Chen J, Xia L, Long Z. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. The Lancet 2023, 401: 645-654. PMID: 36774935, DOI: 10.1016/s0140-6736(22)02600-9.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeAlteplase groupTenecteplase groupNon-inferiority marginNon-inferiority trialIschemic strokeModified intentionTreat populationEndovascular thrombectomyIntracranial hemorrhageRisk ratioScale scoreAcute ischemic cerebrovascular eventsHealth Stroke Scale scoreMedical Sciences (CAMS) Innovation FundStandard intravenous thrombolysisIschemic cerebrovascular eventsPrimary efficacy outcomePrimary safety outcomeStroke Scale scoreRankin Scale scoreProportion of participantsIntravenous tenecteplaseIntravenous thrombolysis
2022
A Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design
Albers G, Campbell B, Lansberg M, Broderick J, Butcher K, Froehler M, Schwamm L, Nouh A, Liebeskind D, Toy F, Yang M, Massaro L, Schoeffler M, Purdon B. A Phase III, prospective, double-blind, randomized, placebo-controlled trial of thrombolysis in imaging-eligible, late-window patients to assess the efficacy and safety of tenecteplase (TIMELESS): Rationale and design. International Journal Of Stroke 2022, 18: 237-241. PMID: 35262424, DOI: 10.1177/17474930221088400.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeInternal carotid arteryPlacebo-controlled trialRankin Scale scoreSymptom onsetDay 90Scale scoreMiddle cerebral artery occlusionEfficacy of tenecteplaseLate-window patientsSafety of tenecteplaseSymptomatic intracranial hemorrhageCerebral artery occlusionLarge vessel occlusionPhase IIIPrimary efficacy objectiveBetter clinical outcomesAdverse eventsArtery occlusionEndovascular thrombectomyIschemic strokeMCA occlusionClinical outcomesIntracranial hemorrhageSalvageable tissue
2021
Thrombolysis in Mild Stroke
Asdaghi N, Romano J, Gardener H, Campo-Bustillo I, Purdon B, Khan Y, Gulati D, Broderick J, Schwamm L, Smith E, Saver J, Sacco R, Khatri P. Thrombolysis in Mild Stroke. Stroke 2021, 52: e586-e589. PMID: 34496619, DOI: 10.1161/strokeaha.120.033466.Peer-Reviewed Original ResearchConceptsNIHSS scoreClinical practiceHealth Stroke Scale scoreMild ischemic stroke patientsMedian NIHSS scoreTrial of thrombolysisStroke Scale scoreIschemic stroke patientsProportion of patientsBroad clinical practiceRoutine clinical practiceSyndromic severityTrial cohortStroke patientsMild strokeMild patientsNeurological syndromeAlteplasePatientsScale scoreLess severityMaRISSComparable deficitsNational InstituteSeverityTenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design
Li S, Campbell B, Schwamm L, Fisher M, Parsons M, Li H, Pan Y, Wang Y, . Tenecteplase Reperfusion therapy in Acute ischaemic Cerebrovascular Events-II (TRACE II): rationale and design. Stroke And Vascular Neurology 2021, 7: 71-76. PMID: 34446531, PMCID: PMC8899655, DOI: 10.1136/svn-2021-001074.Peer-Reviewed Original ResearchMeSH KeywordsBrain IschemiaFibrinolytic AgentsHumansProspective StudiesReperfusionStrokeTenecteplaseTreatment OutcomeUnited StatesConceptsAcute ischemic strokeExcellent functional outcomeFunctional outcomeReperfusion therapyRt-PAAcute ischemic cerebrovascular eventsIntravenous thrombolysis therapyMajor neurological improvementSecondary efficacy outcomesHealth Stroke ScaleIschemic cerebrovascular eventsSymptomatic intracranial hemorrhageFavorable functional outcomeIschemic stroke onsetPrimary study outcomeRankin Scale 0Non-inferiority studyTissue-type plasminogen activatorCerebrovascular eventsNeurological improvementStroke ScaleEfficacy outcomesIschemic strokeStroke onsetThrombolysis therapy
2020
Evaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study
Hummel J, Verma A, Calkins H, Schwamm L, Gress D, Wells D, Souza J, Hokanson R, Hemingway L, Stromberg K, Hoyt R, Wickliffe A, DeLurgio D, Boersma L. Evaluation of stroke incidence with duty‐cycled multielectrode‐phased radiofrequency ablation of persistent atrial fibrillation results of the VICTORY AF Study. Journal Of Cardiovascular Electrophysiology 2020, 31: 1289-1297. PMID: 32270538, DOI: 10.1111/jce.14483.Peer-Reviewed Original ResearchConceptsDevice-related strokesAcute procedural successAtrial fibrillationAF trialSecondary outcomesStroke incidenceProcedural successAF studyStroke/transient ischemic attackVitamin K antagonist anticoagulationMajor structural heart diseasePulmonary vein stenosisTransient ischemic attackIncidence of strokeStructural heart diseaseNumber of patientsVitamin K antagonismAtrial fibrillation resultsRigorous clinical evaluationIDE trialIschemic attackNeurologist assessmentPersAF patientsAF burdenPV stenosisCerebral Small Vessel Diseases and Sleep Related Strokes
Lauer A, Ay H, Bianchi M, Charidimou A, Boulouis G, Ayres A, Vashkevich A, Schwab K, Singhal A, Viswanathan A, Rost N, Goldstein J, Rosand J, Schwamm L, Greenberg S, Gurol M. Cerebral Small Vessel Diseases and Sleep Related Strokes. Journal Of Stroke And Cerebrovascular Diseases 2020, 29: 104606. PMID: 31937490, DOI: 10.1016/j.jstrokecerebrovasdis.2019.104606.Peer-Reviewed Original ResearchConceptsSmall vessel diseaseCerebral small vessel diseaseSmall artery occlusionIntracerebral hemorrhageIschemic strokeHemorrhagic strokeICH patientsVessel diseasePresence of SVDCerebral amyloid angiopathyLobar intracerebral hemorrhageICH cohortArtery occlusionSymptom onsetAmyloid angiopathyHemodynamic changesIS cohortRisk factorsStroke systemsCausative ClassificationStrokePatientsCohortDeep locationDisease
2019
Resource utilisation among patients transferred for intracerebral haemorrhage
Zachrison K, Aaronson E, Mahmood S, Rosand J, Viswanathan A, Schwamm L, Goldstein J. Resource utilisation among patients transferred for intracerebral haemorrhage. Stroke And Vascular Neurology 2019, 4: 223. PMID: 32030206, PMCID: PMC6979870, DOI: 10.1136/svn-2019-000255.Peer-Reviewed Original ResearchMeSH KeywordsAcademic Medical CentersAge FactorsAgedAged, 80 and overCerebral HemorrhageCritical CareFemaleGlasgow Coma ScaleHumansIntensive Care UnitsMaleMiddle AgedNeurosurgical ProceduresPatient AdmissionPatient TransferProspective StudiesRegistriesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeConceptsGlasgow Coma ScoreIntracerebral hemorrhageSurgical interventionICH scoreAcademic hospitalBaseline Glasgow Coma ScoreIntensive care unit admissionCare unit admissionSingle academic hospitalPrimary intracerebral hemorrhageUrban academic hospitalLess frequent useCollected registryICU stayUnit admissionComa ScoreConsecutive patientsIntraventricular hemorrhagePrimary outcomePrimary patientsPatientsHospitalLogistic regressionHemorrhageResource utilisationThe Mild and Rapidly Improving Stroke Study (MaRISS): Rationale and design
Romano J, Gardener H, Campo-Bustillo I, Khan Y, Riley N, Tai S, Sacco R, Khatri P, Smith E, Schwamm L. The Mild and Rapidly Improving Stroke Study (MaRISS): Rationale and design. International Journal Of Stroke 2019, 14: 983-986. PMID: 31496438, DOI: 10.1177/1747493019873595.Peer-Reviewed Original ResearchConceptsStroke symptomsStroke Impact Scale-16Actual treatment ratesMild ischemic strokePrimary safety outcomeSymptomatic hemorrhagic transformationProportion of patientsThird of patientsProspective observational studyEffect of alteplaseAcute stroke trialsLong-term outcomesPredictors of outcomeAlteplase treatmentHemorrhagic transformationIschemic strokeRankin ScaleSecondary outcomesBarthel IndexPrimary outcomeResidual disabilityStroke presentationRetrospective studyStroke StudyStroke trials
2018
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, Peterson E, Schwamm L, Fonarow G, Smith S, Bettger J, Wang D, Li H, Xian Y, Wang Y. Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2018, 11: e001968. PMID: 30557048, DOI: 10.1161/circoutcomes.115.001968.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaChinaClinical CompetenceDisability EvaluationEvidence-Based MedicineFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk FactorsSmoking CessationStrokeStroke RehabilitationThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeConceptsAcute ischemic strokeIschemic strokeOptimal complianceStroke careChina National Stroke RegistryEvidence-based performance measuresMultivariable Cox modelNational Stroke RegistryFavorable functional outcomeProspective cohort studyEvidence-based guidelinesRoutine clinical practiceCause of deathIntravenous tPAStroke recurrenceStroke RegistryCohort studyNationwide registryClinical outcomesFunctional outcomeCare measuresImproved outcomesHospital measuresCox modelClinical practicePrestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke
Etherton M, Siddiqui K, Schwamm L. Prestroke selective serotonin reuptake inhibitor use and functional outcomes after ischaemic stroke. Stroke And Vascular Neurology 2018, 3: 9. PMID: 29600002, PMCID: PMC5870643, DOI: 10.1136/svn-2017-000119.Peer-Reviewed Original ResearchConceptsSelective serotonin reuptake inhibitorsAcute ischemic strokeIschemic strokeLength of staySSRI useFunctional outcomeSelective serotonin reuptake inhibitor useSerotonin reuptake inhibitor useGuidelines-Stroke registrySerotonin reuptake inhibitorsMultivariate regression analysisAmbulatory statusSymptomatic hemorrhageConsecutive patientsInhibitor useMotor recoveryReuptake inhibitorsFunctional recoveryStroke recoveryUnivariate analysisData registryDrug listMultivariate analysisStrokeLower likelihood
2017
Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials
Smith E, Saver J, Cox M, Liang L, Matsouaka R, Xian Y, Bhatt D, Fonarow G, Schwamm L. Increase in Endovascular Therapy in Get With The Guidelines-Stroke After the Publication of Pivotal Trials. Circulation 2017, 136: 2303-2310. PMID: 28982689, DOI: 10.1161/circulationaha.117.031097.Peer-Reviewed Original ResearchConceptsEndovascular thrombectomyEVT useEligible patientsIschemic strokePivotal trialsCase volumeStroke systemsHealth Stroke Scale scoreGuidelines-Stroke programStroke Scale scoreMean case volumeGuidelines-StrokeEndovascular therapyMore patientsPatient eligibilityPatientsClinical practiceScale scoreHospitalStrokeTrialsNational InstituteStroke durationLinear regressionThrombectomyImmediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers
Boulouis G, Siddiqui K, Lauer A, Charidimou A, Regenhardt R, Viswanathan A, Leslie-Mazwi T, Rost N, Schwamm L. Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to Nonthrombectomy Centers. Stroke 2017, 48: 2297-2300. PMID: 28687641, DOI: 10.1161/strokeaha.117.017607.Peer-Reviewed Original ResearchConceptsThrombectomy-capable stroke centersEndovascular thrombectomyVascular imagingCurrent guidelinesAlberta Stroke Program Early CT ScoreUnnecessary transfersHealth Stroke ScaleAcute ischemic strokeMain outcome variablesBaseline vascularStroke ScaleIschemic strokeStroke centersCT scoreFutile transfersPatientsEfficient triageHospitalYielded sensitivityOutcome variablesOptimal selection criteriaNational InstituteStrokeImagingOcclusion levelAssociation Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes
Khan N, Siddiqui F, Goldstein J, Cox M, Xian Y, Matsouaka R, Heidenreich P, Peterson E, Bhatt D, Fonarow G, Schwamm L, Smith E. Association Between Previous Use of Antiplatelet Therapy and Intracerebral Hemorrhage Outcomes. Stroke 2017, 48: 1810-1817. PMID: 28596454, DOI: 10.1161/strokeaha.117.016290.Peer-Reviewed Original ResearchConceptsAntiplatelet therapyIntracerebral hemorrhageHospital mortalityPrevious useDiagnosis of ICHCombination antiplatelet therapyGuidelines-Stroke hospitalsPrestroke antiplatelet therapyTerms of comorbiditiesOral anticoagulant therapyIntracerebral hemorrhage outcomesAPT groupHigh-risk profileHospital presentationAnticoagulant therapyBaseline characteristicsAntiplatelet agentsHospital characteristicsHigh riskPatientsRisk profileMortalityTherapyAPT useComorbiditiesStroke of Known Cause and Underlying Atrial Fibrillation (STROKE-AF) randomized trial: Design and rationale
Bernstein R, Kamel H, Granger C, Kowal R, Ziegler P, Schwamm L. Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE-AF) randomized trial: Design and rationale. American Heart Journal 2017, 190: 19-24. PMID: 28760209, DOI: 10.1016/j.ahj.2017.04.007.Peer-Reviewed Original ResearchConceptsApparent atrial fibrillationInsertable cardiac monitorSmall vessel diseaseLarge vessel atherosclerosisStandard of careVessel diseaseIschemic strokeAtrial fibrillationPost-market clinical trialArrhythmia monitoringSecondary stroke preventionOral anticoagulation therapyContinuous arrhythmia monitoringAntithrombotic treatmentOral anticoagulationAnticoagulation therapyStroke preventionIntracranial atherosclerosisStroke etiologyClinical trialsIncidence rateCardiac monitorPatientsCardiac monitoringStrokeTimely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated
Sauser Zachrison K, Levine D, Fonarow G, Bhatt D, Cox M, Schulte P, Smith E, Suter R, Xian Y, Schwamm L. Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated. Circulation Cardiovascular Quality And Outcomes 2017, 10: e003148. PMID: 28283469, PMCID: PMC5369604, DOI: 10.1161/circoutcomes.116.003148.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAngioplasty, Balloon, CoronaryDelivery of Health Care, IntegratedFemaleFibrinolytic AgentsHumansMaleMiddle AgedMyocardial ReperfusionOrganizational ObjectivesPatient Care TeamProspective StudiesQuality ImprovementQuality Indicators, Health CareRegistriesST Elevation Myocardial InfarctionStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorUnited StatesConceptsST-segment elevation myocardial infarctionAcute ischemic strokeDTN timeD2B timeTimely reperfusionMyocardial infarctionHospital CompareGuidelines-Coronary Artery DiseaseHospital performanceHierarchical linear regression modelingEligible patientsGuidelines-StrokeNeedle timeSTEMI patientsBalloon timeIschemic strokeArtery diseaseHospital proportionLinear regression modelingProspective studyHospital differencesAIS carePatientsCare processesSpearman's rank correlation coefficient
2016
Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization
Man S, Cox M, Patel P, Smith E, Reeves M, Saver J, Bhatt D, Xian Y, Schwamm L, Fonarow G. Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization. Stroke 2016, 48: 412-419. PMID: 28008094, DOI: 10.1161/strokeaha.116.014426.Peer-Reviewed Original ResearchConceptsHealthcare Facilities Accreditation ProgramPSC certificationStroke patientsJoint CommissionIntravenous tissue-type plasminogen activator useHospital risk-adjusted mortalityAcute ischemic stroke patientsStroke qualityAcute ischemic stroke admissionsCare qualityPrimary stroke center certificationGuidelines-Stroke hospitalsStroke center certificationIschemic stroke patientsIschemic stroke admissionsRisk-adjusted mortalityEvidence-based careSystems of careAccreditation programGuidelines-StrokeHospital outcomesNeedle timeStroke admissionsCenter certificationGroup of hospitalsEndovascular Stroke Treatment Outcomes After Patient Selection Based on Magnetic Resonance Imaging and Clinical Criteria
Leslie-Mazwi TM, Hirsch JA, Falcone GJ, Schaefer PW, Lev MH, Rabinov JD, Rost NS, Schwamm L, González RG. Endovascular Stroke Treatment Outcomes After Patient Selection Based on Magnetic Resonance Imaging and Clinical Criteria. JAMA Neurology 2016, 73: 1-7. PMID: 26524074, DOI: 10.1001/jamaneurol.2015.3000.Peer-Reviewed Original ResearchConceptsMagnetic resonance imagingSelection of patientsClinical criteriaFavorable outcomeSuccessful reperfusionMRS scoreLTB patientsIschemic strokeTerminal internal carotid artery occlusionResonance imagingInternal carotid artery occlusionStroke treatment outcomesEndovascular stroke treatmentAcute ischemic strokeCarotid artery occlusionProspective cohort studyMiddle cerebral arterySpecific magnetic resonance imagingInfarct volume determinationArtery occlusionCohort studyStroke treatmentCerebral arteryEndovascular treatmentPatient selection
2015
Safety and efficacy of desmoteplase given 3–9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries (DIAS-3): a double-blind, randomised, placebo-controlled phase 3 trial
Albers G, von Kummer R, Truelsen T, Jensen J, Ravn G, Grønning B, Chabriat H, Chang K, Davalos A, Ford G, Grotta J, Kaste M, Schwamm L, Shuaib A, Investigators D. Safety and efficacy of desmoteplase given 3–9 h after ischaemic stroke in patients with occlusion or high-grade stenosis in major cerebral arteries (DIAS-3): a double-blind, randomised, placebo-controlled phase 3 trial. The Lancet Neurology 2015, 14: 575-584. PMID: 25937443, DOI: 10.1016/s1474-4422(15)00047-2.Peer-Reviewed Original ResearchConceptsMajor cerebral arteriesHigh-grade stenosisRankin Scale scoreIschemic strokeSymptom onsetCerebral arteryDay 90Scale scorePlacebo-controlled phase 3 trialComputer-generated randomisation listMajor cerebral artery occlusionModified Rankin Scale scoreSymptomatic cerebral edemaSymptomatic intracranial hemorrhageBaseline National InstitutesHealth Stroke ScaleSerious adverse eventsCerebral artery occlusionPhase 3 trialModified Rankin ScaleRandomisation listStroke ScaleStudy drugAdverse eventsArtery occlusionPatient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care
Xian Y, O’Brien E, Fonarow G, Olson D, Schwamm L, Hannah D, Lindholm B, Maisch L, Lytle B, Greiner M, Wu J, Peterson E, Pencina M, Hernandez A. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care. American Heart Journal 2015, 170: 36-45.e11. PMID: 26093862, DOI: 10.1016/j.ahj.2015.04.008.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAged, 80 and overAnticoagulantsAntidepressive AgentsCohort StudiesDecision MakingDepressionFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPatient Care PlanningPatient Outcome AssessmentPatient PreferencePatient SatisfactionProspective StudiesQuality of LifeRetrospective StudiesSecondary PreventionStrokeTreatment OutcomeConceptsComparative effectiveness researchPatient prefersStroke careStroke patientsTreatment optionsEffectiveness researchMajor adverse cardiovascular eventsAdverse cardiovascular eventsIndividual patient preferencesHealth care providersOutcomes Research InstitutePatient-centered comparative effectiveness researchOutcomes research studiesHealth care communityGuidelines-StrokeCardiovascular eventsOral anticoagulantsPatient-centered outcomes research studiesStatin therapyPatient characteristicsPrimary outcomeClinical effectivenessComparative safetyPatient preferencesClinical trials
2014
Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion
LaBuzetta J, Yoo A, Ali S, Fitzpatrick K, Leslie-Mazwi T, Hirsch J, Schwamm L, Rost N. Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion. Journal Of Stroke And Cerebrovascular Diseases 2014, 23: 2527-2532. PMID: 25238927, PMCID: PMC4256100, DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.020.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overArterial Occlusive DiseasesBrain IschemiaCombined Modality TherapyEndovascular ProceduresFemaleFibrinolytic AgentsHumansInjections, Intra-ArterialLogistic ModelsMaleMiddle AgedPatient DischargeProspective StudiesRegional Blood FlowStrokeStroke RehabilitationTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntra-arterial therapyProximal artery occlusionArtery occlusionIndependent predictorsAIS patientsPoststroke outcomesFavorable outcomeAcute ischemic stroke patientsIntravenous tissue plasminogen activatorInstitutional stroke databaseAcute ischemic strokeIschemic stroke patientsOnly independent predictorTissue plasminogen activatorEligible patientsHospital mortalityTPA administrationIschemic strokeStroke databaseAtrial fibrillationEarly outcomesPrespecified protocolStroke patientsPatient subgroupsUnfavorable outcome