Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly?

Strbian, Daniel; Ringleb, Peter; Michel, Patrik; Breuer, Lorenz; Ollikainen, Jyrki; Murao, Kei; Seiffge, David J.; Jung, Simon; Obach, Victor; Weder, Bruno; Eskandari, Ashraf; Gensicke, Henrik; Chamorro, Angel; Mattle, Heinrich P.; Engelter, Stefan; Leys, Didier; Numminen, Heikki; Köhrmann, Martin; Hacke, Werner and Tatlisumak, Turgut (2013). Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly? Stroke, 44(10), pp. 2913-2916. Lippincott Williams & Wilkins 10.1161/STROKEAHA.111.000819

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BACKGROUND AND PURPOSE We previously reported increased benefit and reduced mortality after ultra-early stroke thrombolysis in a single center. We now explored in a large multicenter cohort whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis. METHODS Prospectively collected data of consecutive ischemic stroke patients who received i.v. thrombolysis in 10 European stroke centers were merged. Logistic regression tested association between treatment delays, as well as excellent 3-month outcome (modified Rankin scale, 0-1), and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale. RESULTS In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome (P<0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11-1.70; P=0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76-1.32; P=0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78-1.39; P=0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14-2.01; P<0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality. CONCLUSIONS I.v. thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Jung, Simon; Weder, Bruno J. and Mattle, Heinrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

17 Jun 2014 09:02

Last Modified:

29 Oct 2015 12:06

Publisher DOI:

10.1161/STROKEAHA.111.000819

PubMed ID:

23970791

Uncontrolled Keywords:

emergencies, ischemic stroke, onset to needle time, outcome, thrombolysis

BORIS DOI:

10.7892/boris.53451

URI:

https://boris.unibe.ch/id/eprint/53451

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