Predicted impact of intravenous thrombolysis on prognosis of general population of stroke patients: simulation model

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Abstract
COST comprised 1197 patients with acute stroke recruited during 1991-3 from an area of Copenhagen.4 These patients constituted 88% of stroke patients in the area: the remaining 12% were not admitted because they had very mild stroke or died before reaching hospital; none would have qualified for alteplase treatment. The figure shows the impact of each exclusion criterion from the US trial1 on the COST population. Only 64 (5%) of the patients fulfilled all criteria. Nineteen of these patients died, and 17 had full recovery (defined as 95 or 100 points on the Barthel index at discharge1) These patients would therefore not have benefited from alteplase treatment. The 28 patients who survived but did not achieve full recovery could have benefited from treatment. With a 32% relative increase in patients with full recovery, five patients (17×0.32=5 (95% confidence interval 1 to 12)) or 0.4% (0.1% to 1.0%) of the stroke population would have benefited if alteplase had been available.