Intravenous thrombolysis for ischemic stroke in the golden hour

propensity-matched analysis from the SITS-EAST registry

Georgios Tsivgoulis, Aristeidis H. Katsanos, Pavla Kadlecová, Anna Czlonkowska, Adam Kobayashi, Miroslav Brozman, Viktor Švigelj, Laszlo Csiba, Klara Fekete, Janika Kõrv, Vida Demarin, Aleksandras Vilionskis, Dalius Jatuzis, Yakup Krespi, Chrissoula Liantinioti, Sotirios Giannopoulos, Robert Mikulik

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

As there are scarce data regarding the outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) within 60 min from symptom onset (“golden hour”), we sought to compare outcomes between AIS patients treated within [GH(+)] and outside [GH(−)] the “golden hour” by analyzing propensity score matched data from the SITS-EAST registry. Clinical recovery (CR) at 2 and 24 h was defined as a reduction of ≥10 points on NIHSS-score or a total NIHSS-score of ≤3 at 2 and 24 h, respectively. A relative reduction in NIHSS-score of ≥40% at 2 h was considered predictive of complete recanalization (CREC). Symptomatic intracranial hemorrhage (sICH) was defined using SITS-MOST criteria. Favorable functional outcome (FFO) was defined as a mRS-score of 0–1 at 3 months. Out of 19,077 IVT-treated AIS patients, 71 GH(+) patients were matched to 6882 GH(−) patients, with no differences in baseline characteristics (p > 0.1). GH(+) had higher rates of CR at 2 (31.0 vs. 12.4%; p < 0.001) and 24 h (41 vs. 27%; p = 0.010), CREC at 2 h (39 vs. 21%; p < 0.001) and FFO (46.5 vs. 34.0%; p = 0.028) at 3 months. The rates of sICH and 3-month mortality did not differ (p > 0.2) between the two groups. GH(+) was associated with 2-h CR (OR: 5.34; 95% CI 2.53–11.03) and CREC (OR: 2.38; 95% CI 1.38–4.09), 24-h CR (OR: 1.88; 95% CI 1.08–3.26) and 3-month FFO (OR: 2.02; 95% CI 1.15–3.54) in multivariable logistic regression models adjusting for potential confounders. In conclusion, AIS treated with IVT within the GH seems to have substantially higher odds of early neurological recovery, CREC, 3-month FFO and functional improvement.

Original languageEnglish (US)
Pages (from-to)912-920
Number of pages9
JournalJournal of Neurology
Volume264
Issue number5
DOIs
StatePublished - May 1 2017

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4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
Registries
Stroke
Logistic Models
Propensity Score
Intracranial Hemorrhages

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

Intravenous thrombolysis for ischemic stroke in the golden hour : propensity-matched analysis from the SITS-EAST registry. / Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Kadlecová, Pavla; Czlonkowska, Anna; Kobayashi, Adam; Brozman, Miroslav; Švigelj, Viktor; Csiba, Laszlo; Fekete, Klara; Kõrv, Janika; Demarin, Vida; Vilionskis, Aleksandras; Jatuzis, Dalius; Krespi, Yakup; Liantinioti, Chrissoula; Giannopoulos, Sotirios; Mikulik, Robert.

In: Journal of Neurology, Vol. 264, No. 5, 01.05.2017, p. 912-920.

Research output: Contribution to journalArticle

Tsivgoulis, G, Katsanos, AH, Kadlecová, P, Czlonkowska, A, Kobayashi, A, Brozman, M, Švigelj, V, Csiba, L, Fekete, K, Kõrv, J, Demarin, V, Vilionskis, A, Jatuzis, D, Krespi, Y, Liantinioti, C, Giannopoulos, S & Mikulik, R 2017, 'Intravenous thrombolysis for ischemic stroke in the golden hour: propensity-matched analysis from the SITS-EAST registry', Journal of Neurology, vol. 264, no. 5, pp. 912-920. https://doi.org/10.1007/s00415-017-8461-8
Tsivgoulis, Georgios ; Katsanos, Aristeidis H. ; Kadlecová, Pavla ; Czlonkowska, Anna ; Kobayashi, Adam ; Brozman, Miroslav ; Švigelj, Viktor ; Csiba, Laszlo ; Fekete, Klara ; Kõrv, Janika ; Demarin, Vida ; Vilionskis, Aleksandras ; Jatuzis, Dalius ; Krespi, Yakup ; Liantinioti, Chrissoula ; Giannopoulos, Sotirios ; Mikulik, Robert. / Intravenous thrombolysis for ischemic stroke in the golden hour : propensity-matched analysis from the SITS-EAST registry. In: Journal of Neurology. 2017 ; Vol. 264, No. 5. pp. 912-920.
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abstract = "As there are scarce data regarding the outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) within 60 min from symptom onset (“golden hour”), we sought to compare outcomes between AIS patients treated within [GH(+)] and outside [GH(−)] the “golden hour” by analyzing propensity score matched data from the SITS-EAST registry. Clinical recovery (CR) at 2 and 24 h was defined as a reduction of ≥10 points on NIHSS-score or a total NIHSS-score of ≤3 at 2 and 24 h, respectively. A relative reduction in NIHSS-score of ≥40{\%} at 2 h was considered predictive of complete recanalization (CREC). Symptomatic intracranial hemorrhage (sICH) was defined using SITS-MOST criteria. Favorable functional outcome (FFO) was defined as a mRS-score of 0–1 at 3 months. Out of 19,077 IVT-treated AIS patients, 71 GH(+) patients were matched to 6882 GH(−) patients, with no differences in baseline characteristics (p > 0.1). GH(+) had higher rates of CR at 2 (31.0 vs. 12.4{\%}; p < 0.001) and 24 h (41 vs. 27{\%}; p = 0.010), CREC at 2 h (39 vs. 21{\%}; p < 0.001) and FFO (46.5 vs. 34.0{\%}; p = 0.028) at 3 months. The rates of sICH and 3-month mortality did not differ (p > 0.2) between the two groups. GH(+) was associated with 2-h CR (OR: 5.34; 95{\%} CI 2.53–11.03) and CREC (OR: 2.38; 95{\%} CI 1.38–4.09), 24-h CR (OR: 1.88; 95{\%} CI 1.08–3.26) and 3-month FFO (OR: 2.02; 95{\%} CI 1.15–3.54) in multivariable logistic regression models adjusting for potential confounders. In conclusion, AIS treated with IVT within the GH seems to have substantially higher odds of early neurological recovery, CREC, 3-month FFO and functional improvement.",
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T1 - Intravenous thrombolysis for ischemic stroke in the golden hour

T2 - propensity-matched analysis from the SITS-EAST registry

AU - Tsivgoulis, Georgios

AU - Katsanos, Aristeidis H.

AU - Kadlecová, Pavla

AU - Czlonkowska, Anna

AU - Kobayashi, Adam

AU - Brozman, Miroslav

AU - Švigelj, Viktor

AU - Csiba, Laszlo

AU - Fekete, Klara

AU - Kõrv, Janika

AU - Demarin, Vida

AU - Vilionskis, Aleksandras

AU - Jatuzis, Dalius

AU - Krespi, Yakup

AU - Liantinioti, Chrissoula

AU - Giannopoulos, Sotirios

AU - Mikulik, Robert

PY - 2017/5/1

Y1 - 2017/5/1

N2 - As there are scarce data regarding the outcomes of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) within 60 min from symptom onset (“golden hour”), we sought to compare outcomes between AIS patients treated within [GH(+)] and outside [GH(−)] the “golden hour” by analyzing propensity score matched data from the SITS-EAST registry. Clinical recovery (CR) at 2 and 24 h was defined as a reduction of ≥10 points on NIHSS-score or a total NIHSS-score of ≤3 at 2 and 24 h, respectively. A relative reduction in NIHSS-score of ≥40% at 2 h was considered predictive of complete recanalization (CREC). Symptomatic intracranial hemorrhage (sICH) was defined using SITS-MOST criteria. Favorable functional outcome (FFO) was defined as a mRS-score of 0–1 at 3 months. Out of 19,077 IVT-treated AIS patients, 71 GH(+) patients were matched to 6882 GH(−) patients, with no differences in baseline characteristics (p > 0.1). GH(+) had higher rates of CR at 2 (31.0 vs. 12.4%; p < 0.001) and 24 h (41 vs. 27%; p = 0.010), CREC at 2 h (39 vs. 21%; p < 0.001) and FFO (46.5 vs. 34.0%; p = 0.028) at 3 months. The rates of sICH and 3-month mortality did not differ (p > 0.2) between the two groups. GH(+) was associated with 2-h CR (OR: 5.34; 95% CI 2.53–11.03) and CREC (OR: 2.38; 95% CI 1.38–4.09), 24-h CR (OR: 1.88; 95% CI 1.08–3.26) and 3-month FFO (OR: 2.02; 95% CI 1.15–3.54) in multivariable logistic regression models adjusting for potential confounders. In conclusion, AIS treated with IVT within the GH seems to have substantially higher odds of early neurological recovery, CREC, 3-month FFO and functional improvement.

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