Page 115

Karger_ESC London_2013

London, United Kingdom 2013 16 Acute stroke: emergency management, stroke units and complications B 11:30 - 11:40 BASELINE NIHSS-ADJUSTED TIME WINDOW FOR IV TPA IN ACUTE ISCHEMIC STROKE M. MUCHADA LOPEZ1, M. RUBIERA DEL FUEYO2, D. RODRIGUEZ- LUNA3, J. PA-GOLA PEREZ DE LA BLANCA4, A.A. FLORES FLORES5, J. ARAUJO KALLAS6, E. SANJUAN MENENDEZ7, P. MELER AMELLA8, J. ALVAREZ SABIN9, M. RIBO JACO-BI10, C.A. MOLINA CATERIANO11 VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN1,VALL D’HE-BRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN2, VALL D’HEBRON UNIVER-SITY HOSPITAL, BARCELONA, SPAIN3, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN4, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN5, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN6, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN7, VALL D’HEBRON UNI-VERSITY HOSPITAL, BARCELONA, SPAIN8, VALL D’HEBRON UNIVERSITY HOSPI-TAL, Cerebrovasc Dis 2013; 35 (suppl 3)1-854 115 BARCELONA, SPAIN9, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN10, VALL D’HEBRON UNIVERSITY HOSPITAL, BARCELONA, SPAIN11 Background: The beneficial effect of tPA on functional outcome decreases progressively over-time. However, given the differential pattern of arterial occlusion, stroke severity and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aim to identify the impact of the time-to-treatment according to stroke severity on functional outcome in patients with acute ischemic stroke. Methods: Were included patients treated with tPA in a University Hospital from 2001-2011. Patients were grouped according to NIHSS severity in minor NIHSS≤8, moderate NIHSS 9-15 and severe stroke NIHSS≥16. We sequentially analyzed time-to-treatment to achieve favorable outcome, defined as mRS ≤2 at 3 months. Results: Of a total of 514 patients, 22.2% had minor stroke, 31.5% moderate stroke, and 46.3% severe stroke. Favorable outcome occurred in 79.6%, 62.1%, and 26.9% respective-ly. In patients with minor stroke, time-to-treatment did not predict outcome. In these patiens, younger age (OR 0.234; 95% CI 0.063-0.866; p=0.03), previous mRS score (OR 0.852; 95% CI 0.756-0.960; p=0.009), and absence of proximal occlusion (OR 0.035; 95% CI 0.004-0.332; p=0.004) independently predicted favorable outcome. In moderate stroke patients, time-to-treatment ≤ 120min (OR 0.136; 95% IC: 0.024-0.784; p=0.026) and age (OR 0.904; 95% IC: 0.842-0.970; p=0.005) emerged as independent predictors of favorable outcome. In severe stroke patients, time-to-treatment did not predict favorable outcome. Adjusting for associated variables only age was an independent predictor (OR 0.941, 95% CI 0.896-0.988; p=0.015). Conclusions: The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity. The window for favorable outcome was ≤120 min for moderate strokes. In contrast, time-to-treatment appeared unrelated to functional outcome in minor and severe stroke. 15 Acute stroke: emergency management, stroke units and complications B 11:20 - 11:30 Stroke thrombolysis: Save a minute – save a day A. Meretoja1, M. Keshtkaran2, T. Tatlisumak3, M.W. Parsons4, S.M. Davis5, G.A. Donnan6, L. Churilov7 University of Melbourne, Melbourne, AUSTRALIA1,The Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA2, Helsinki University Central Hospital, Helsinki, FINLAND3, John Hunter Hospital, Newcastle, AUSTRALIA4, The Royal Melbourne Hospi-tal, Melbourne, AUSTRALIA5, The Florey Institute of Neuroscience and Mental Health, Mel-bourne, AUSTRALIA6, The Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA7 BACKGROUND Although intravenous thrombolytic therapy (tPA) for ischaemic stroke is more effective when delivered early after symptom onset, in-hospital delays of >60 mins are common. We quantified the benefit patients gain from faster treatment. METHODS Observational data of consecutive tPA cases (n=2258) from SITS-Australia and Helsinki thrombolysis registries were used to provide real-life distributions of age, gender, stroke severi-ty, treatment delays and 3-month modified Rankin Scale (mRS) in standard practice. The treat-ment effect of tPA over time was derived from the published meta-analysis of tPA trials and this was used to model the shift in 3-month mRS distributions with reducing treatment delays. These mRS probabilities were further used to estimate expected lifetimes and levels of disabil-ity for individual patients and then to derive disability adjusted life years (DALYs) gained by faster treatment. RESULTS The median patient was 70 years of age, had NIHSS of 10 and was treated 125 mins from stroke onset. Reducing this delay by 20 mins resulted in one month of extra disability-free life. In the whole tPA cohort each minute gained provided 1.3 (95% CI 1.30-1.34) days of ex-tra healthy life. When older age was down-weighted as is often done for societal reasons, each minute still provided 0.87 (0.85-0.88) days of healthy life. The effect of being faster varied with the patients’ life-expectancy - per minute saved it was: 0.5 days gained for old & severe (age 82, NIHSS 22), 0.7 days for old & mild (age 87, NIHSS 4), 1.6 days for young & mild (age 30, NIHSS 3), and 2.1 days for young & severe (age 32, NIHSS 23). CONCLUSIONS Time does matter. Reasonably achievable reductions of 15-30 mins in stroke thrombolysis de-lays result in weeks to months of additional healthy life for each treated patient. For the great-est gains, thrombolysis would have to be given pre-hospital. Failing that, stroke centres should work on shortening their door-to-needle time to <30 minutes.


Karger_ESC London_2013
To see the actual publication please follow the link above