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

Autoři	TSIVGOULIS G. KATSANOS A.H. KADLECOVA P. CZLONKOWSKA A. KOBAYASHI A. BROZMAN M. SVIGELJ V. CSIBA L. FEKETE K. KORV J. DEMARIN V. VILIONSKIS A. JATUZIS D. KRESPI Y. LIANTINIOTI C. GIANNOPOULOS S. MIKULÍK Robert
Rok publikování	2017
Druh	Článek v odborném periodiku
Časopis / Zdroj	European Journal of Neurology
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
Doi	http://dx.doi.org/10.1007/s00415-017-8461-8
Klíčová slova	Intravenous thrombolysis; Acute ischemic stroke; Golden hour; Onset-to-treatment time; Mobile stroke unit
Popis	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 ae10 points on NIHSS-score or a total NIHSS-score of ae3 at 2 and 24 h, respectively. A relative reduction in NIHSS-score of ae40% 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.