Key result
Shorter door-to-needle times linked to improved long-term functional outcomes and lower stroke mortality.
Why the study?
Existing data and clinical trials could not determine whether faster intravenous thrombolytic therapy translates into better long-term functional outcomes after acute ischemic stroke among patients treated with endovascular thrombectomy.
Do shorter door-to-needle times for intravenous thrombolytic therapy improve long-term functional outcomes and mortality in older patients with acute ischemic stroke?
Cohort (n=42,859)
Yes
Do shorter door-to-needle times for intravenous thrombolytic therapy improve long-term functional outcomes and mortality in older patients with acute ischemic stroke?
Shorter door-to-needle times for intravenous thrombolysis in older acute ischemic stroke patients are associated with better long-term functional outcomes and lower mortality, with benefits dissipating if treatment is delayed beyond 60 minutes.
Supports expedited thrombolysis protocols in older stroke patients; extends observational data but leaves open causal confirmation and guideline updates.
BACKGROUND: Existing 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. METHODS: This 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. RESULTS: <0.001 for each). The benefit dissipated with DTN>60 minutes. CONCLUSIONS: Among 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.
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Man et al. (2023) conducted a cohort in Acute Ischemic Stroke (n=42,859). Shorter door-to-needle (DTN) times vs. Longer door-to-needle (DTN) times was evaluated on Home time (p=<0.001). Shorter door-to-needle times for thrombolytic therapy in older acute ischemic stroke patients were associated with better long-term functional outcomes and lower mortality (P<0.001).
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