C León-Jiménez1, J L Ruiz-Sandoval2, E Chiquete3, M Vega-Arroyo4, A Arauz5, L M Murillo-Bonilla6, A Ochoa-Guzmán3, K Carrillo-Loza7, A Ramos-Moreno8, F Barinagarrementeria9, C Cantú-Brito3. 1. Departamento de Neurología, Hospital «Valentín Gómez Farías», Zapopan, Jalisco, México. 2. Departamento de Neurología, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México; Departamento de Neurociencias, CUCS, Universidad de Guadalajara, Guadalajara, Jalisco, México. Electronic address: jorulej-1nj@prodigy.net.mx. 3. Departamento de Neurología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México. 4. Departamento de Neurología, Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México. 5. Cínica de Enfermedades cerebrovasculares, Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México. 6. Departamento de Neurología, Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México. 7. Departamento de Medicina Interna, Hospital Civil de Guadalajara «Juan I Menchaca», Guadalajara, Jalisco, México. 8. Área Científica, Sanofi México, Ciudad de México, México. 9. Departamento de Neurología, Hospital Ángeles de Querétaro, Querétaro, México.
Abstract
INTRODUCTION: Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. METHODS: We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. RESULTS: Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. CONCLUSIONS: A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis.
INTRODUCTION: Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. METHODS: We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. RESULTS: Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. CONCLUSIONS: A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis.