Christian H Nolte1, Martin Ebinger2, Jan F Scheitz2, Alexander Kunz2, Hebun Erdur2, Frederik Geisler2, Tim Bastian Braemswig2, Michal Rozanski2, Joachim E Weber2, Matthias Wendt2, Katja Zieschang2, Jochen B Fiebach2, Kersten Villringer2, Ulrike Grittner2, Sabina Kaczmarek2, Matthias Endres2, Heinrich J Audebert2. 1. From the Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.-B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.-B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany (C.H.N., M.E., J.F.S., A.K., T.-B.B., M.R., J.B.F., K.V., U.G., M.E., H.J.A.); Berliner Feuerwehr, Berlin Fire Brigade, Berlin, Germany (S.K.); German Center for Cardiovascular Research (DZHK), Berlin Partner Site, Charité-Universitätsmedizin Berlin, Berlin, Germany (M. Endres); German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site, Charité-Universitätsmedizin Berlin, Berlin, Germany (M. Endres); Berlin Institute of Health (BIH), Berlin, Germany (C.H.N., J.F.S., T.-B.B., M. Endres); Medical Park Berlin Humboldtmühle, Berlin, Germany (M. Ebinger); and Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin (U.G.). christian.nolte@charite.de. 2. From the Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.-B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Department of Neurology, Berlin Institute of Health, Berlin, Germany (C.H.N., M. Ebinger, J.F.S., A.K., H.E., F.G., T.-B.B., M.R., J.E.W., M.W., K.Z., J.B.F., K.V., M. Endres, H.J.A.); Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany (C.H.N., M.E., J.F.S., A.K., T.-B.B., M.R., J.B.F., K.V., U.G., M.E., H.J.A.); Berliner Feuerwehr, Berlin Fire Brigade, Berlin, Germany (S.K.); German Center for Cardiovascular Research (DZHK), Berlin Partner Site, Charité-Universitätsmedizin Berlin, Berlin, Germany (M. Endres); German Center for Neurodegenerative Diseases (DZNE), Berlin Partner Site, Charité-Universitätsmedizin Berlin, Berlin, Germany (M. Endres); Berlin Institute of Health (BIH), Berlin, Germany (C.H.N., J.F.S., T.-B.B., M. Endres); Medical Park Berlin Humboldtmühle, Berlin, Germany (M. Ebinger); and Institute of Medical Biometrics and Clinical Epidemiology, Charité - Universitätsmedizin Berlin (U.G.).
Abstract
BACKGROUND AND PURPOSE: Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily -independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency. METHODS: This observational, retrospective analysis included all patients with acute ischemic stroke depending on assistance before stroke who received intravenous thrombolysis either on the Stroke Emergency Mobile (STEMO) or through conventional in-hospital care (CC) in a tertiary stroke center (Charité, Campus Benjamin Franklin, Berlin) during routine care. Prespecified outcomes were modified Rankin Scale scores of 0 to 3 and survival at 3 months, as well as symptomatic intracranial hemorrhage. Outcomes were adjusted in multivariable logistic regression. RESULTS: Between February 2011 and March 2015, 122 of 427 patients (28%) treated on STEMO and 142 of 505 patients (28%) treated via CC needed assistance before stroke. Median onset-to-treatment times were 97 (interquartile range, 69-159; STEMO) and 135 (interquartile range, 98-184; CC; P<0.001) minutes. After 3 months, modified Rankin Scale scores of 0 to 3 was observed in 48 STEMO patients (39%) versus 35 CC patients (25%; P=0.01) and 86 (70%, STEMO) versus 85 (60%, CC) patients were alive (P=0.07). After adjustment, STEMO care was favorable with respect to modified Rankin Scale scores of 0 to 3 (odds ratio, 1.99; 95% confidence interval, 1.02-3.87; P=0.042) with a nonsignificant result for survival (odds ratio, 1.73; 95% confidence interval, 0.95-3.16; P=0.07). Symptomatic intracranial hemorrhage occurred in 5 STEMO versus 12 CC patients (4.2% versus 8.5%; P=0.167). CONCLUSIONS: The results of this study suggest that earlier, prehospital (as compared with in-hospital) start of intravenous thrombolysis in acute ischemic stroke may translate into better clinical outcome in patients with prestroke dependency. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02358772.
BACKGROUND AND PURPOSE: Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily -independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency. METHODS: This observational, retrospective analysis included all patients with acute ischemic stroke depending on assistance before stroke who received intravenous thrombolysis either on the Stroke Emergency Mobile (STEMO) or through conventional in-hospital care (CC) in a tertiary stroke center (Charité, Campus Benjamin Franklin, Berlin) during routine care. Prespecified outcomes were modified Rankin Scale scores of 0 to 3 and survival at 3 months, as well as symptomatic intracranial hemorrhage. Outcomes were adjusted in multivariable logistic regression. RESULTS: Between February 2011 and March 2015, 122 of 427 patients (28%) treated on STEMO and 142 of 505 patients (28%) treated via CC needed assistance before stroke. Median onset-to-treatment times were 97 (interquartile range, 69-159; STEMO) and 135 (interquartile range, 98-184; CC; P<0.001) minutes. After 3 months, modified Rankin Scale scores of 0 to 3 was observed in 48 STEMO patients (39%) versus 35 CC patients (25%; P=0.01) and 86 (70%, STEMO) versus 85 (60%, CC) patients were alive (P=0.07). After adjustment, STEMO care was favorable with respect to modified Rankin Scale scores of 0 to 3 (odds ratio, 1.99; 95% confidence interval, 1.02-3.87; P=0.042) with a nonsignificant result for survival (odds ratio, 1.73; 95% confidence interval, 0.95-3.16; P=0.07). Symptomatic intracranial hemorrhage occurred in 5 STEMO versus 12 CC patients (4.2% versus 8.5%; P=0.167). CONCLUSIONS: The results of this study suggest that earlier, prehospital (as compared with in-hospital) start of intravenous thrombolysis in acute ischemic stroke may translate into better clinical outcome in patients with prestroke dependency. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02358772.
Authors: Martin Ebinger; Bob Siegerink; Alexander Kunz; Matthias Wendt; Joachim E Weber; Eugen Schwabauer; Frederik Geisler; Erik Freitag; Julia Lange; Janina Behrens; Hebun Erdur; Ramanan Ganeshan; Thomas Liman; Jan F Scheitz; Ludwig Schlemm; Peter Harmel; Katja Zieschang; Irina Lorenz-Meyer; Ira Napierkowski; Carolin Waldschmidt; Christian H Nolte; Ulrike Grittner; Edzard Wiener; Georg Bohner; Darius G Nabavi; Ingo Schmehl; Axel Ekkernkamp; Gerhard J Jungehulsing; Bruno-Marcel Mackert; Andreas Hartmann; Jessica L Rohmann; Matthias Endres; Heinrich J Audebert Journal: JAMA Date: 2021-02-02 Impact factor: 56.272
Authors: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: Peter Harmel; Martin Ebinger; Erik Freitag; Ulrike Grittner; Irina Lorenz-Meyer; Ira Napierkowski; Christian H Nolte; Bob Siegerink; Heinrich J Audebert Journal: Neurol Res Pract Date: 2019-06-03