Impact of Intravenous Alteplase Door-to-Needle Times on 2-Year Mortality in Patients With Acute Ischemic Stroke

• Type of Material: Article
• Authors: Nirav Bhatt, Emory University; Anika Backster, Emory University; Moges S Ido, Georgia State University; Raul Nogueira, Emory University; Rana Bayakly, Georgia Department of Public Health; David Wright, Emory University; Michael Frankel, Emory University
• Language: English
• Date: 2021-10-13
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Bhatt, Backster, Ido, Nogueira, Bayakly, Wright and Frankel.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fneur.2021.747185
• Title of Journal or Parent Work: FRONTIERS IN NEUROLOGY
• Volume: 12
• Start Page: 747185
• End Page: 747185
• Keywords: tissue plasminogen activator; THROMBOLYSIS; mortality; acute stroke care; HEART-DISEASE; ATRIAL-FIBRILLATION; LONG-TERM SURVIVAL; Life Sciences & Biomedicine; thrombolytic therapy; OUTCOMES; Science & Technology; POOLED ANALYSIS; QUALITY-OF-CARE; FUNCTIONAL STATUS; Clinical Neurology; DISPARITIES; TISSUE-PLASMINOGEN ACTIVATOR; Neurosciences & Neurology; door to needle time; Neurosciences
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Objective: We sought to determine whether administration of Intravenous Thrombolysis (IVT) to patients with Acute Ischemic Stroke (AIS) within 60 min from hospital arrival is associated with lower 2-year mortality. Methods: This retrospective study was conducted among patients receiving IVT in hospitals participating in the Georgia Coverdell Acute Stroke Registry (GCASR) from January 1, 2008 through June 30, 2018. Two-year mortality data was obtained by linking the 2008–2018 Georgia Discharge Data System data and the 2008–2020 Georgia death records. We analyzed the study population in two groups based on the time from hospital arrival to initiation of IVT expressed as Door to Needle time (DTN) in a dichotomized (DTN ≤ 60 vs. > 60 min) fashion. Results: The median age of patients was 68 years, 49.4% were females, and the median NIHSS was 9. DTN ≤60 min was associated with lower 30-day [odds ratio (OR), 0.62; 95% CI, 0.52–0.73; P < 0.0001], 1-year (OR, 0.71; 95% CI, 0.61–0.83; P < 0.0001) and 2-year (OR, 0.76; 95% CI, 0.65–0.88; P = 0.001) mortality as well as lower rates of sICH at 36 h (OR, 0.57; 95% CI, 0.43–0.75; P = 0.0001), higher rates of ambulation at discharge (OR, 1.38; 95% CI, 1.25–1.53; P < 0.0001) and discharge to home (OR, 1.36; 95% CI, 1.23–1.52; P < 0.0001). Conclusion: Faster DTN in patients with AIS was associated with lower 2-year mortality across all age, gender and race subgroups. These findings reinforce the need for intensifying quality improvement measures to reduce DTN in AIS patients.