Objective: To study the association between comorbid diseases and long-term mortality in acute ischemic stroke patients with and without an intravenous recombinant tissue plasminogen activator (rt-PA) treatment using a national database. 

Materials and Methods: This study was a retrospective cohort study. The database used in this study was a Universal Health Coverage (UHC) insurance of Thailand. The inclusion criteria were consecutive adult patients diagnosed as acute ischemic stroke and admitted to the hospital. The study period was between October 1st, 2011 and September 30th, 2014. Mortality was defined as a 1-year mortality after acute ischemic stroke. We analyzed if comorbid diseases associated with the 1-year mortality with regards of the rt-PA treatment.

Results: During the study period, there were 120,545 patients met the study criteria. Of those, 4,610 patients (3.8%) received rt-PA. The 1-year mortality rate in the rt-PA group and no rt-PA group were 1,129 (24.5%) and 30,910 (26.7%), respectively (p value 0.001). The rt-PA group had significantly higher proportions of eight comorbid diseases than the no rt-PA group; mostly cardiovascular diseases such as hypertension, coronary artery disease, heart failure, or atrial fibrillation.

Conclusions: The 1-year mortality rate in acute ischemic stroke was significantly lower if treated with the rt-PA. Cardiovascular comorbid diseases may increase risk of mortality if treated with the rt-PA.

Keywords: intravenous recombinant tissue plasminogen activator, hypertension, cardiovascular disease