Long-term outcomes improved with shorter door-to-needle times for stroke patients who receive thrombolysis

Référence

Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA 2020;323(21):2170-2184.

Sommaire

The relationship between faster administration of thrombolytic therapy on hospital arrival ("door-to-needle time") and long-term outcomes for acute stroke patients is unknown. Using clinical data from the Get With the Guidelines - Stroke program database, these investigators identified 61,426 Medicare beneficiaries who presented with acute ischemic stroke between 2006 and 2016 and were treated with tPA within 4.5 hours of the last known time they were well. These patients had a median age of 80 years, 82% were non-Hispanic white, and the median door-to-needle time was 65 minutes. Overall, 21% of the cohort had a door-to-needle time of less than 45 minutes and 44% had a door-to-needle time of less than 60 minutes. The primary outcomes were all-cause mortality and all-cause re-admissions at 1 year. As compared with patients who were treated within 45 minutes of hospital arrival, patients who received tPA after 45 minutes had higher mortality (35.0% vs 30.8%; hazard ratio [HR] 1.13; 95% CI 1.09 - 1.18) and higher re-admissions (40.8% vs 38.4%; HR 1.08; 1.05 - 1.12). This was also true for patients treated within 60 minutes or after 60 minutes (mortality: 35.8% vs 32.1%; re-admissions: 41.3% vs 39.1%). Notably, every 15-minute increase in door-to-needle time up to 90 minutes was associated with a higher risk of mortality and re-admissions.