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J Neurol. 2017 May;264(5):912-920. doi: 10.1007/s00415-017-8461-8. Epub 2017 Mar 18.

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

Author information

1
Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece. tsivgoulisgiorg@yahoo.gr.
2
International Clinical Research Center and Neurology Department, St. Anne's Hospital, Brno, Czech Republic. tsivgoulisgiorg@yahoo.gr.
3
Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece.
4
Department of Neurology, University of Ioannina, Ioannina, Greece.
5
International Clinical Research Center and Neurology Department, St. Anne's Hospital, Brno, Czech Republic.
6
Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
7
Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
8
Neurology Department, University Hospital Nitra, Nitra, Slovakia.
9
Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.
10
Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
11
Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
12
Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia.
13
Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius, Lithuania.
14
Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania.
15
Neurology Department and Stroke Center, Memorial Şişli Hospital, Istanbul, Turkey.
16
Medical Faculty of Masaryk University, Brno, Czech Republic.

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.

KEYWORDS:

Acute ischemic stroke; Golden hour; Intravenous thrombolysis; Mobile stroke unit; Onset-to-treatment time

PMID:
28315960
DOI:
10.1007/s00415-017-8461-8
[Indexed for MEDLINE]

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