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Journal of Neurology

, Volume 264, Issue 5, pp 912–920 | Cite as

Intravenous thrombolysis for ischemic stroke in the golden hour: propensity-matched analysis from the SITS-EAST registry

  • Georgios TsivgoulisEmail author
  • 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
Original Communication

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.

Keywords

Intravenous thrombolysis Acute ischemic stroke Golden hour Onset-to-treatment time Mobile stroke unit 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Ethical standards

The research documented in the submitted manuscript has been carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and has been approved by the appropriate ethics committees of the participating institutions.

Sources of funding

Dr Georgios Tsivgoulis, Pavla Kadlecova and Robert Mikulik have been supported by the project no. LQ1605 from the National Program of Sustainability II (MEYS CR).

Supplementary material

415_2017_8461_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Georgios Tsivgoulis
    • 1
    • 2
    Email author
  • Aristeidis H. Katsanos
    • 1
    • 3
  • Pavla Kadlecová
    • 2
  • Anna Czlonkowska
    • 4
    • 5
  • Adam Kobayashi
    • 4
  • Miroslav Brozman
    • 6
  • Viktor Švigelj
    • 7
  • Laszlo Csiba
    • 8
  • Klara Fekete
    • 8
  • Janika Kõrv
    • 9
  • Vida Demarin
    • 10
  • Aleksandras Vilionskis
    • 11
  • Dalius Jatuzis
    • 12
  • Yakup Krespi
    • 13
  • Chrissoula Liantinioti
    • 1
  • Sotirios Giannopoulos
    • 3
  • Robert Mikulik
    • 2
    • 14
  1. 1.Second Department of Neurology, “Attikon” Hospital, School of MedicineUniversity of AthensAthensGreece
  2. 2.International Clinical Research Center and Neurology DepartmentSt. Anne’s HospitalBrnoCzech Republic
  3. 3.Department of NeurologyUniversity of IoanninaIoanninaGreece
  4. 4.Second Department of NeurologyInstitute of Psychiatry and NeurologyWarsawPoland
  5. 5.Department of Experimental and Clinical PharmacologyMedical University of WarsawWarsawPoland
  6. 6.Neurology DepartmentUniversity Hospital NitraNitraSlovakia
  7. 7.Department of Vascular Neurology and Neurological Intensive CareUniversity Medical Centre LjubljanaLjubljanaSlovenia
  8. 8.Department of Neurology, Medical and Health Science CenterUniversity of DebrecenDebrecenHungary
  9. 9.Department of Neurology and NeurosurgeryUniversity of TartuTartuEstonia
  10. 10.Department of NeurologySestre Milosrdnice University Hospital CentreZagrebCroatia
  11. 11.Department of Neurology and NeurosurgeryVilnius University and Republican Vilnius University HospitalVilniusLithuania
  12. 12.Department of Neurology and Neurosurgery, Center for NeurologyVilnius UniversityVilniusLithuania
  13. 13.Neurology Department and Stroke CenterMemorial Şişli HospitalIstanbulTurkey
  14. 14.Medical Faculty of Masaryk UniversityBrnoCzech Republic

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