Useless, because we still don't know how fast tPA needs to be delivered to get 100% recovery. This chest thumping needs to stop for minor incremental gains.
Treating Patients With Stroke Earlier Can Save Lives, Prevent Disability
Initiating stroke treatment just 15 minutes faster can save lives and prevent disability, according to a study published in JAMA.
The study also determined that hospitals that treat patients with stroke more frequently have better outcomes.
For the study, Reza Jahan, MD, University of California at Los Angeles, Los Angeles, California, and colleagues examined data for 6,756 patients with anterior circulation large vessel occlusion acute ischaemic stroke treated with endovascular-reperfusion therapy with onset-to-puncture time of ≤8 hours. The patients’ median age was 69.5 years, and 51.2% were women.
The researchers found that median onset-to-puncture time was 230 minutes and median door-to-puncture time was 87 minutes, with substantial reperfusion in 85.9% of patients.
Adverse events were symptomatic intracranial haemorrhage in 6.7% of patients and in-hospital mortality/hospice discharge in 19.6% of patients.
At discharge, 36.9% of patients ambulated independently and 23% had functional independence.
In onset-to-puncture analysis, time-outcome relationships were non-linear with steeper slopes between 30 to 270 minutes than 271 to 480 minutes. In the 30- to 270-minute timeframe, faster onset to puncture in 15-minute increments was associated with higher likelihood of achieving independent ambulation at discharge (absolute increase = 1.14%; 95% confidence interval [CI], 0.75%-1.53%), lower in-hospital mortality/hospice discharge (absolute decrease = -0.77%; 95% CI, -1.07% to -0.47%), and lower risk of symptomatic intracranial haemorrhage (absolute decrease = -0.22%; 95% CI, -0.40% to -0.03%).
Faster door-to-puncture times were similarly associated with improved outcomes, including in the 30- to 120-minute window, higher likelihood of achieving discharge to home (absolute increase = 2.13%; 95% CI, 0.81%-3.44%) and lower in-hospital mortality/hospice discharge (absolute decrease = -1.48%; 95% CI, -2.60% to -0.36%) for each 15-minute increment.
The study also found that hospitals that perform endovascular reperfusion therapy on >50 patients per year generally begin treatment faster than hospitals that perform <30; and that initial treatment tends to be delayed at hospitals that are not certified as comprehensive stroke centres or are located in the Northeast, as well as for people who have a stroke during hospital “off hours” -- weekends, holidays, and before 7:00 AM and after 6:00 PM on weekdays.
Treatment delays also are more likely for people who live alone or fail to recognise their own stroke symptoms.
Based on the study results, the American Heart Association has already published new goals regarding how fast patients should be treated at comprehensive stroke centres, concluded Dr. Jahan.
Reference: http://doi.org/10.1001/jama.2019.8286
SOURCE: MediaSource
The study also determined that hospitals that treat patients with stroke more frequently have better outcomes.
For the study, Reza Jahan, MD, University of California at Los Angeles, Los Angeles, California, and colleagues examined data for 6,756 patients with anterior circulation large vessel occlusion acute ischaemic stroke treated with endovascular-reperfusion therapy with onset-to-puncture time of ≤8 hours. The patients’ median age was 69.5 years, and 51.2% were women.
The researchers found that median onset-to-puncture time was 230 minutes and median door-to-puncture time was 87 minutes, with substantial reperfusion in 85.9% of patients.
Adverse events were symptomatic intracranial haemorrhage in 6.7% of patients and in-hospital mortality/hospice discharge in 19.6% of patients.
At discharge, 36.9% of patients ambulated independently and 23% had functional independence.
In onset-to-puncture analysis, time-outcome relationships were non-linear with steeper slopes between 30 to 270 minutes than 271 to 480 minutes. In the 30- to 270-minute timeframe, faster onset to puncture in 15-minute increments was associated with higher likelihood of achieving independent ambulation at discharge (absolute increase = 1.14%; 95% confidence interval [CI], 0.75%-1.53%), lower in-hospital mortality/hospice discharge (absolute decrease = -0.77%; 95% CI, -1.07% to -0.47%), and lower risk of symptomatic intracranial haemorrhage (absolute decrease = -0.22%; 95% CI, -0.40% to -0.03%).
Faster door-to-puncture times were similarly associated with improved outcomes, including in the 30- to 120-minute window, higher likelihood of achieving discharge to home (absolute increase = 2.13%; 95% CI, 0.81%-3.44%) and lower in-hospital mortality/hospice discharge (absolute decrease = -1.48%; 95% CI, -2.60% to -0.36%) for each 15-minute increment.
The study also found that hospitals that perform endovascular reperfusion therapy on >50 patients per year generally begin treatment faster than hospitals that perform <30; and that initial treatment tends to be delayed at hospitals that are not certified as comprehensive stroke centres or are located in the Northeast, as well as for people who have a stroke during hospital “off hours” -- weekends, holidays, and before 7:00 AM and after 6:00 PM on weekdays.
Treatment delays also are more likely for people who live alone or fail to recognise their own stroke symptoms.
Based on the study results, the American Heart Association has already published new goals regarding how fast patients should be treated at comprehensive stroke centres, concluded Dr. Jahan.
Reference: http://doi.org/10.1001/jama.2019.8286
SOURCE: MediaSource
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