Intravenous thrombolysis for ischemic stroke in the golden hour: propensity-matched analysis from the SITS-EAST registry

Abstract

As there are scarce data regarding the outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) within 60 min from symptom onset ("golden hour"), we sought to compare outcomes between AIS patients treated within [GH(+)] and outside [GH(-)] the "golden hour" by analyzing propensity score matched data from the SITS-EAST registry. Clinical recovery (CR) at 2 and 24 h was defined as a reduction of ≥10 points on NIHSS-score or a total NIHSS-score of ≤3 at 2 and 24 h, respectively. A relative reduction in NIHSS-score of ≥40% at 2 h was considered predictive of complete recanalization (CREC). Symptomatic intracranial hemorrhage (sICH) was defined using SITS-MOST criteria. Favorable functional outcome (FFO) was defined as a mRS-score of 0-1 at 3 months. Out of 19,077 IVT-treated AIS patients, 71 GH(+) patients were matched to 6882 GH(-) patients, with no differences in baseline characteristics (p > 0.1). GH(+) had higher rates of CR at 2 (31.0 vs. 12.4%; p < 0.001) and 24 h (41 vs. 27%; p = 0.010), CREC at 2 h (39 vs. 21%; p < 0.001) and FFO (46.5 vs. 34.0%; p = 0.028) at 3 months. The rates of sICH and 3-month mortality did not differ (p > 0.2) between the two groups. GH(+) was associated with 2-h CR (OR: 5.34; 95% CI 2.53-11.03) and CREC (OR: 2.38; 95% CI 1.38-4.09), 24-h CR (OR: 1.88; 95% CI 1.08-3.26) and 3-month FFO (OR: 2.02; 95% CI 1.15-3.54) in multivariable logistic regression models adjusting for potential confounders. In conclusion, AIS treated with IVT within the GH seems to have substantially higher odds of early neurological recovery, CREC, 3-month FFO and functional improvement.

Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

“…As shown in our study, the differences between PCS and ACS in regard to ischemic tolerance and the response to hemorrhagic complication do not appear to change the time‐dependent nature of vascular recanalization. This result was also supported by the strong association between AIS treated with IVT within the first hour (the golden hour) and the substantially higher chance of complete recanalization and the early reversal of neurological deficits reported in the results of the Safe Implementation of Treatments in Stroke–East registry (Tsivgoulis et al, ). Moreover, a strong association between late recanalization (˃6 hr) and unfavorable outcomes for BAO patients after endovascular therapy was also observed in the Basilar Artery International Cooperation Study (BASICS; Vergouwen et al, ).…”

Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets

“…After dichotomization according to the history of dual antiplatelet intake prior to stroke onset, patients in the treatment group (patients with history of dual antiplatelet pretreatment) were matched to control group patients without any prior antiplatelet treatment at stroke onset. For matching, we used a structured, iterative propensity score model with inclusion of all baseline characteristics, except for the history of dual antiplatelet pretreatment, with the primary objective to maximize the balance in the distribution of possible confounders between the 2 aforementioned groups . The corresponding propensity score of the treatment variable (history of dual antiplatelet intake) was calculated for each subject, and a nearest neighbor matching algorithm with a 1:1 allocation was subsequently implemented to match eligible patients in the treatment group (patients with history of dual antiplatelet pretreatment) to patients in the control group (patients without history of antiplatelet pretreatment).…”

Optimising acute stroke care organisation: a simulation study to assess the potential to increase intravenous thrombolysis rates and patient gains

“…12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) Median time from hospital arrival to laboratory examination, min (IQR)…”

“…12 13 Various studies have investigated factors associated with efficiency in each part of the acute stroke pathway. Although it has been generally established that delay on the part of patients and/or bystanders is a primary factor in delaying hospital arrival, 14 interventions aimed at improving optimal response by calling 911 immediately have exhibited varying success, and many lack sustained Median on scene time, min (IQR) 20 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) Median transportation time, min (IQR) 17 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Median time from hospital arrival to neurological examination, min (range)…”