G Tsivgoulis1,2, A H Katsanos1,3, P Kadlecová2, A Czlonkowska4,5, A Kobayashi4,6, M Brozman7, V Švigelj8, L Csiba9, K Fekete9, J Kõrv10, V Demarin11, A Vilionskis12, D Jatuzis13, Y Krespi14, T Karapanayiotides15, S Giannopoulos3, R Mikulik2,16. 1. Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 2. International Clinical Research Center and Neurology Department, St Anne's Hospital, Brno, Czech Republic. 3. Department of Neurology, University of Ioannina, Ioannina, Greece. 4. Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw. 5. Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw. 6. Department of Neuroradiology, Interventional Stroke and Cerebrovascular Disease Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland. 7. Department of Neurology, Faculty Hospital Nitra, Constantine University Nitra, Nitra, Slovakia. 8. Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia. 9. Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary. 10. Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia. 11. Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia. 12. Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius. 13. Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania. 14. Neurology Department and Stroke Center, Memorial Sisli Hospital Istanbul, Istanbul, Turkey. 15. Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece. 16. Medical Faculty of Masaryk University, Brno, Czech Republic.
Abstract
BACKGROUND AND PURPOSE: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. METHODS: We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months, (iii) functional independence defined as an mRS score of 0-2 at 3 months and (iv) 3-month mortality. RESULTS: Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60-140) vs. 65 (IQR, 47-95) min, P < 0.001] and door-to-imaging [40 (IQR, 20-90) vs. 24 (IQR, 15-35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). CONCLUSIONS: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.
BACKGROUND AND PURPOSE: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. METHODS: We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months, (iii) functional independence defined as an mRS score of 0-2 at 3 months and (iv) 3-month mortality. RESULTS: Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60-140) vs. 65 (IQR, 47-95) min, P < 0.001] and door-to-imaging [40 (IQR, 20-90) vs. 24 (IQR, 15-35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). CONCLUSIONS: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.
Authors: Louise E Craig; Sandy Middleton; Helen Hamilton; Fern Cudlip; Victoria Swatzell; Andrei V Alexandrov; Elizabeth Lightbody; Dame Caroline Watkins; Sheeba Philip; Dominique A Cadilhac; Elizabeth McInnes; Simeon Dale; Anne W Alexandrov Journal: Interv Neurol Date: 2018-09-25
Authors: Eva S Emmett; Abdel Douiri; Iain J Marshall; Charles D A Wolfe; Anthony G Rudd; Ajay Bhalla Journal: PLoS One Date: 2019-02-21 Impact factor: 3.240