Abstract WMP11: Intravenous Thrombolysis in Patients Without versus With Visible Occlusion: A Secondary Analysis From the AcT Trial
Bibliographic record
Abstract
Background: Around 70% of patients who present with acute ischemic stroke(AIS) have no visible occlusion on baseline imaging. In this post-hoc analysis from the AcT trial, we aimed to assess if there is a difference in safety/efficacy of intravenous thrombolysis in patients presenting with AIS symptoms with no visible occlusion(NVO) versus with visible occlusion(VO). We further sought to determine if this effect differed between tenecteplase and alteplase in the NVO group. Methods: Primary outcome was symptomatic intracerebral hemorrhage(SICH) within 24 hours. Secondary outcomes included modified Rankin Scale(mRS) 0-1, mRS 0-2, ordinal mRS at 90-120 days, and hemorrhage on imaging as defined by Heidelberg bleeding classification. Mixed effects regression model with quasi Poisson link was used to estimate NVO effect while adjusting for age, sex, NIHSS, thrombolytic type, and onset to needle time. Findings: Of the 1577 patients, 1470(93.2%) patients who received thrombolysis within 4.5h and with available baseline CT angiogram were included in the study. Of these, 479 (30.4%; 247: tenecteplase and 232: alteplase) were in NVO and 991 (69.6%; 509: tenecteplase and 482: alteplase) were in VO group. Patients in NVO group were younger (median 71y vs 75y), with less severe strokes (median NIHSS 6 vs 12). Patients in NVO group had significantly lower rates of death as compared to VO group (8.1% vs 19.1%, adjusted risk ratio(adjRR)1.5, 95%CI:1.0-2.6). There was no difference in rates of SICH (2.3% vs 3.6%, adjRR 0.99, 95%CI:0.5-2.1) or rates of 90-d mRS 0-1 (43.3% vs 31.9%, adjRR 1.0, 95%CI:0.8-1.1). All safety and efficacy outcomes were similar between alteplase and tenecteplase in NVO group. Interpretation: Thrombolysis is just as safe in patients with AIS symptoms with NVO as compared to those with VO on baseline imaging. When thrombolysis is given, there is no difference in outcomes between these group by thrombolytic type.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".