Treatment speed crucial to 1-year stroke survival

Article written by Bruce Sylvester

Door to thrombolytic “needle time” is crucial to 1-year survival in acute ischemic stroke, researchers reported on June 2, 2020 in JAMA/Journal of the American Medical Association.

“Among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator [tPA], shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy, the authors said.

For this retrospective study, investigators enrolled Medicare (USA) beneficiaries aged 65 years who had been treated for acute ischemic stroke with intravenous tPA within 4.5 hours from the time they were reported to be well.

Primary outcomes were 1-year all-cause mortality, all-cause readmission, and the composite of all-cause mortality or readmission.

Among the 61,426 subjects, median age was 80 years, and 43.5% were male.

Median door-to-needle time was 65 minutes (range of 49-88 minutes).

Of the study population total, 48, 666 (79.2%) were treated with tPA and had door-to-needle times of longer than 45 minutes. When compared with those treated within 45 minutes, they had significantly higher all-cause mortality, 35.0% vs 30.8% at 1 year after treatment. They also had higher all-cause readmission (40.8% vs 38.4%) and higher all-cause mortality or readmission (56.0% vs 52.1%)

Among 34,367 subjects (55.9%) treated with tPA with door-to-needle times of longer than 60 minutes, and when compared with those treated within 60 minutes, they had significantly higher all-cause mortality (35.8% vs 32.1%) at 1-year, higher all-cause readmission (41.3% vs 39.1%), and higher all-cause mortality or readmission (56.8% vs 53.1%)

Notably, the researchers reported that every 15-minute increase in door-to-needle times within 90 minutes after hospital arrival (but not after 90 minutes) was associated with higher all-cause mortality, with higher all-cause readmission and with higher all-cause mortality or readmission.

Writing in an Editor’s Note published simultaneously by JAMA, Christopher Muth, MD, a neurologist in Chicago and assistant professor at Rush University Medical Center, said that this new study fills a gap in current medical awareness, “by convincingly documenting the association between faster treatment with intravenous tPA and better long-term outcomes, including 1-year mortality. The findings are yet another reason for clinicians and health systems to design stroke services that can treat patients with acute ischemic stroke with thrombolytic therapy in a rapid fashion.”