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Stroke. 2013 Oct;44(10):2913-6. doi: 10.1161/STROKEAHA.111.000819. Epub 2013 Aug 22.

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

Author information

1
From the Departments of Neurology and Stroke Units, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, University of Heidelberg, Heidelberg, Germany (P.R., W.H.); Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology, Tampere University Hospital, Tampere, Finland (J.O., H.N.); Department of Neurology, University Lille Nord de France (K.M., D.L.); Department of Neurology and Stroke Units, University Hospital Basel, Basel, Switzerland (D.J.S., H.G., S.E.); Department of Neurology, University of Bern, Bern, Switzerland (S.J., B.W., H.P.M.); Department of Neurology, Hospital Clínic Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain (V.O., A.C.); and Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland (B.W.).

Abstract

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.

KEYWORDS:

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

PMID:
23970791
DOI:
10.1161/STROKEAHA.111.000819
[Indexed for MEDLINE]
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