Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke.
| dc.contributor.author | Man, Shumei | |
| dc.contributor.author | Solomon, Nicole | |
| dc.contributor.author | Mac Grory, Brian | |
| dc.contributor.author | Alhanti, Brooke | |
| dc.contributor.author | Uchino, Ken | |
| dc.contributor.author | Saver, Jeffrey L | |
| dc.contributor.author | Smith, Eric E | |
| dc.contributor.author | Xian, Ying | |
| dc.contributor.author | Bhatt, Deepak L | |
| dc.contributor.author | Schwamm, Lee H | |
| dc.contributor.author | Hussain, Muhammad Shazam | |
| dc.contributor.author | Fonarow, Gregg C | |
| dc.date.accessioned | 2024-06-06T14:46:19Z | |
| dc.date.available | 2024-06-06T14:46:19Z | |
| dc.date.issued | 2023-07 | |
| dc.description.abstract | BackgroundExisting data and clinical trials could not determine whether faster intravenous thrombolytic therapy (IVT) translates into better long-term functional outcomes after acute ischemic stroke among those treated with endovascular thrombectomy (EVT). Patient-level national data can provide the required large population to study the associations between earlier IVT, versus later, with longitudinal functional outcomes and mortality in patients receiving IVT+EVT combined treatment.MethodsThis cohort study included older US patients (age ≥65 years) who received IVT within 4.5 hours or EVT within 7 hours after acute ischemic stroke using the linked 2015 to 2018 Get With The Guidelines-Stroke and Medicare database (38 913 treated with IVT only and 3946 with IVT+EVT). Primary outcome was home time, a patient-prioritized functional outcome. Secondary outcomes included all-cause mortality in 1 year. Multivariate logistic regression and Cox proportional hazards models were used to evaluate the associations between door-to-needle (DTN) times and outcomes.ResultsAmong patients treated with IVT+EVT, after adjusting for patient and hospital factors, including onset-to-EVT times, each 15-minute increase in DTN times for IVT was associated with significantly higher odds of zero home time in a year (never discharged to home) (adjusted odds ratio, 1.12 [95% CI, 1.06-1.19]), less home time among those discharged to home (adjusted odds ratio, 0.93 per 1% of 365 days [95% CI, 0.89-0.98]), and higher all-cause mortality (adjusted hazard ratio, 1.07 [95% CI, 1.02-1.11]). These associations were also statistically significant among patients treated with IVT but at a modest degree (adjusted odds ratio, 1.04 for zero home time, 0.96 per 1% home time for those discharged to home, and adjusted hazard ratio 1.03 for mortality). In the secondary analysis where the IVT+EVT group was compared with 3704 patients treated with EVT only, shorter DTN times (≤60, 45, and 30 minutes) achieved incrementally more home time in a year, and more modified Rankin Scale 0 to 2 at discharge (22.3%, 23.4%, and 25.0%, respectively) versus EVT only (16.4%, P<0.001 for each). The benefit dissipated with DTN>60 minutes.ConclusionsAmong older patients with stroke treated with either IVT only or IVT+EVT, shorter DTN times are associated with better long-term functional outcomes and lower mortality. These findings support further efforts to accelerate thrombolytic administration in all eligible patients, including EVT candidates. | |
| dc.identifier.issn | 0009-7322 | |
| dc.identifier.issn | 1524-4539 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
| dc.relation.ispartof | Circulation | |
| dc.relation.isversionof | 10.1161/circulationaha.123.064053 | |
| dc.rights.uri | ||
| dc.subject | Humans | |
| dc.subject | Brain Ischemia | |
| dc.subject | Fibrinolytic Agents | |
| dc.subject | Treatment Outcome | |
| dc.subject | Thrombolytic Therapy | |
| dc.subject | Thrombectomy | |
| dc.subject | Cohort Studies | |
| dc.subject | Aged | |
| dc.subject | Medicare | |
| dc.subject | United States | |
| dc.subject | Stroke | |
| dc.subject | Endovascular Procedures | |
| dc.subject | Ischemic Stroke | |
| dc.title | Shorter Door-to-Needle Times Are Associated With Better Outcomes After Intravenous Thrombolytic Therapy and Endovascular Thrombectomy for Acute Ischemic Stroke. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Solomon, Nicole|0000-0002-5643-9958 | |
| duke.contributor.orcid | Mac Grory, Brian|0000-0003-3914-8419 | |
| duke.contributor.orcid | Alhanti, Brooke|0000-0003-4243-8062 | |
| duke.contributor.orcid | Xian, Ying|0000-0002-1237-1162 | |
| pubs.begin-page | 20 | |
| pubs.end-page | 34 | |
| pubs.issue | 1 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Staff | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Biostatistics & Bioinformatics | |
| pubs.organisational-group | Ophthalmology | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | Neurology | |
| pubs.organisational-group | Neurology, Neurocritical Care | |
| pubs.organisational-group | Neurology, Stroke and Vascular Neurology | |
| pubs.publication-status | Published | |
| pubs.volume | 148 |
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