Initiating Stroke Tx 15 Minutes Earlier Can Improve Outcomes

Shorter time to endovascular-reperfusion therapy is associated with improved outcomes among patients with acute ischemic stroke (AIS) due to large vessel occlusion, according to a study published in the issue of the Journal of the American Medical Association.

Reza Jahan, M.D., from the University of California in Los Angeles, and colleagues characterized the association of speed of treatment with outcome among 6,756 patients with anterior circulation large vessel occlusion AIS treated with endovascular-reperfusion therapy with onset-to-puncture time of eight hours or less.

The researchers found that time-outcome relationships were nonlinear, with steeper slopes at 30 to 270 minutes compared with 271 to 480 minutes in onset-to-puncture adjusted analysis. In the 30- to 270-minute time frame, faster onset to puncture correlated with an increased likelihood of achieving independent ambulation at discharge, lower in-hospital mortality/hospice discharge, and lower risk for symptomatic intracranial hemorrhage with each 15-minute increment (absolute increase, 1.14 percent [95 percent confidence interval (CI), 0.75 to 1.53 percent]; absolute decreases, −0.77 [95 percent CI, −1.07 to −0.47 percent] and −0.22 percent [95 percent CI, −0.40 to −0.03 percent], respectively). Similar associations with improved outcomes were seen for faster door-to-puncture times, including in the 30- to 120-minute window, with a higher likelihood of achieving discharge to home and lower in-hospital mortality/hospice discharge for each 15-minute increment (absolute increase, 2.13 percent [95 percent CI, 0.81 to 3.44 percent]; absolute decrease, −1.48 percent [95 percent CI, −2.60 to −0.36 percent]).

"The magnitude of the time-benefit relation observed in this study, while requiring validation in an external data set, is clinically meaningful and emphasizes the importance of policies to accelerate treatment start," the authors write.

Several authors disclosed financial ties to the pharmaceutical and medical device industries. The GWTG-Stroke program is sponsored in part by Medtronic and has been funded in the past by pharmaceutical companies.

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