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22. European Stroke Conference 572 © 2013 S. Karger AG, Basel Scientific Programme 30 Acute stroke: emergency management, stroke units and complications Continuous heart rate HR monitoring in patients with acute cerebrovascular events C. Sick1, M. G. Hennerici2 Neurology Department of the University Hospital Mannheim, Mannheim, GERMANY1, Neu-rology Depratment of the University Hospital Mannheim, Mannheim, GERMANY2 BACKGROUND: Although HR monitoring is standardized in stroke unit SU patients, there is small knowledge about its time course after acute cerebrovascular events. We report a new insight to ex-tensive data collection cohorts in patients monitored within 72h after admission. METHODS: In 3513 consecutive stroke patients (intracerebral hemorrhage ICH, transient ischemic attack TIA, ischemic stroke IS) HR values were obtained at least every minute. Over 15 million measurements of HR were averaged in 15min intervals. In case of IS additional subgroup analysis was performed for stroke aetiology (cardioembolic, macroangiopathy, microangiopathy), in case of ICH for localization (typical and atypical) and volume (volume <5ml, 5-20ml and >20ml) as well as for presence and extend of intraventricular hemorrhage IVH and for midline shift MLS (no MLS, MLS <5mmand >5mm). RESULTS: Patients with ICH and IS show initial increase and peak levels after 180min (82+/- 1.2; 79+/-0.4) followed by a slow decrease in the next 70h, whilst TIA patients show no signifi-cant changes within the first 72 hours after onset (Fig. 1). Starting 180min after onset ICB patients showed continuously significant higher (p<0.001) HR values than IS patients and especially high-er values than TIA patients. For ICH patients we found no significant influence of localization on HR values, but with additional factors like increasing volume of ICH, presence of IVH and extend of MLS HR values became significantly higher (Fig. 2). With regard to aetiology cardioembolic strokes showed highest HR values (profile comparable to ICH patients) followed by macroangiopa-thy and microangiopathy, that both lacked the initial significant HR increase. CONCLUSION: Analysis of monitoring HR in SU patients reveals significantly different pattern of HR changes within 72 h after onset, which provides so far unrecognized keys for better classifica-tion, estimation of prognosis and management with useful application in future clinical trials. 29 Acute stroke: emergency management, stroke units and complications Patient Age Linked to Prolonged Door-to-Needle Times in Stroke Thrombolysis. L.G. Gould1, D.J. Sahlas2, J. Fang3, W.J. Oczkowski4, M.K. Kapral5 Investigators of the Registry of the Canadian Stroke Network Hamilton Health Sciences, Hamilton, CANADA1, McMaster University, Hamilton, CANADA2, The Institute for Clinical Evaluative Sciences, Toronto, CANADA3, McMaster University, Hamil-ton, CANADA4, University of Toronto and The Institute for Clinical Evaluative Sciences, Toronto, CANADA5, , , 6, , , 7, , , 8, , , 9, , , 10, , , 11, , , 12, , , 13, , , 14, , , 15 Background: Stroke thrombolysis (tPA) has been the standard of care for acute ischemic stroke for over a decade. A review of current literature confirms that considerable effort has been dedicated to achieving door-to-needle times under 60 minutes. Systemic and institutional factors that lead to delays have been previously examined. Although studies have identified age as a contributing factor to prolonged door to needle times, the effect of age of patients at time of presentation has not been explored independently. We propose that a patient’s age may influence caregiver attitudes and pro-long the administration of stroke thrombolysis. Methods: 1784 patients who received tPA with data for “door to needle” time were identified from consecutive patients at 11 regional stroke centres participating in the Registry of the Canadian Stroke Network (RCSN, 2003-08).Results: The over-all median door to tPA administration in all ages was 72 minutes (IQR 55-94) Prolonged door to needle times were associated with both stroke in the young (18-40 year) (Median 85 IQR 61-102.5) as well as the extreme elderly (91-100 year)(Median 83(IQR 56-99) patients. A U shaped curve is therefore apparent when examining median door to needle time by decade of birth (p=0.0017). (Fig-ure 1.) Conclusions: Stroke in the young as well as in the extreme elderly are both associated with prolonged door to needle times for stroke thrombolysis. Prompt administration of tPA should remain the goal for all eligible candidates regardless of age. E-Poster Terminal 3


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