and 5 other(s)
Background and Aims: Intravenous thrombolysis is a well-established treatment for patients with acute ischemic stroke, and shows better outcomes the sooner it is given. Most studies so far have looked at fixed time intervals or onset-to-needle time. Our aim was to quantify the effect of each minute delay in door-to-needle (DTN) time on survival in real-world patients. Methods: Our nationwide registry-based study included 14845 adult (≥18 years) patients with ischemic stroke receiving thrombolysis from 2010-2017. The exposure was DTN time measured as minutes. The outcome was survival at 7- and 90 days. Analyses of patient characteristics and baseline data were followed by layered multivariable analyses including a wide array of confounders. Results: Median DTN time was 48 minutes, median age 74 years, median NIHSS 8 points and 45% were women. Overall survival was 95% at 7 days and 88% at 90 days. The unadjusted analyses showed a linear relationship between DTN time and survival. The adjusted analyses showed that each minute delay in DTN time on average reduced survival by 0.6% at 7 days (OR 0.994, 95% CI 0.992-0.996), and by 0.5% at 90 days (OR 0.995, 95% CI 0.993-0.997). Conclusions: Our study confirms previous studies in that timely thrombolysis is essential in achieving better outcomes for stroke patients. By showing this per minute in real-world patients, our study serves as a reminder of the importance of speed, and that even the smallest improvements in DTN times are beneficial in survival after stroke thrombolysis.
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