Acute Ischemic Stroke: Shorter Thrombolytic Door-to-Needle Time Tied to Better 1-Year Outcomes

Shorter door-to-needle times may be associated with lower all-cause readmission and lower all-cause mortality at 1 year among acute ischemic stroke patients aged 65 years or older who receive treatment with intravenous tissue plasminogen activator (tPA), according to new findings.

Researchers arrived at their conclusion after performing a retrospective cohort study of Medicare beneficiaries aged 65 years or older (N = 61,426; median age 80 years) who were treated for acute ischemic stroke with intravenous tPA within 4.5 hours from their last known well. Patients received treatment between January 1, 2006, and December 31, 2016, at Get With The Guidelines–Stroke participating hospitals. Follow-up lasted 1 year through December 31, 2017.

The primary outcomes were defined as all-cause readmission, all-cause mortality, and the composite of all-cause mortality or readmission at 1 year post-stroke.

The results of the study indicated that longer door-to-needle times (occurring within 90 minutes of hospital arrival, but not after 90 minutes) were significantly associated with higher likelihood of all-cause readmission at 1 year, with a hazard ratio [HR] per 15-minute increase in time of 1.02, as well as higher all-cause mortality at 1 year, with an HR per 15-minute increase in time of 1.04.

Patients with door-to-needle times lasting longer than 45 minutes had significantly higher all-cause mortality (35.0% vs 30.8%; adjusted HR 1.13), higher all-cause readmission (40.8% vs 38.4%; adjusted HR, 1.08), and higher all-cause mortality or readmission (56.0% vs 52.1%; adjusted HR, 1.09) compared with those treated within 45 minutes.

Patients with door-to-needle times lasting longer than 60 minutes also demonstrated significantly higher all-cause mortality (35.8% vs 32.1%; adjusted hazard ratio [HR] 1.11), higher all-cause readmission (41.3% vs 39.1%; adjusted HR, 1.07), and higher all-cause mortality or readmission (56.8% vs 53.1%; adjusted HR, 1.08) compared with those treated within 60 minutes.

“These findings support efforts to shorten time to thrombolytic therapy,” the researchers concluded.

—Christina Vogt

Reference:
Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA. Published online June 2, 2020. doi:10.1001/jama.2020.5697