Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Ave., Los Angeles, CA 90095-1679, USA.
Circulation. 2011 Feb 22;123(7):750-8. doi: 10.1161/CIRCULATIONAHA.110.974675. Epub 2011 Feb 10.
The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time dependent, and guidelines recommend an arrival to treatment initiation (door-to-needle) time of ≤60 minutes.
Data from acute ischemic stroke patients treated with tPA within 3 hours of symptom onset in 1082 hospitals participating in the Get With the Guidelines-Stroke Program from April 1, 2003, to September 30, 2009 were studied to determine frequency, patient and hospital characteristics, and temporal trends in patients treated with door-to-needle times ≤60 minutes. Among 25 504 ischemic stroke patients treated with tPA, door-to-needle time was ≤60 minutes in only 6790 (26.6%). Patient factors most strongly associated with door-to-needle time ≤60 minutes were younger age, male gender, white race, or no prior stroke. Hospital factors associated with ≤60 minute door-to-needle time included greater annual volumes of tPA-treated stroke patients. The proportion of patients with door-to-needle times ≤60 minutes varied widely by hospital (0% to 79.2%) and increased from 19.5% in 2003 to 29.1% in 2009 (P<0.0001). Despite similar stroke severity, in-hospital mortality was lower (adjusted odds ratio, 0.78; 95% confidence interval, 0.69 to 0.90; P<0.0003) and symptomatic intracranial hemorrhage was less frequent (4.7% versus 5.6%; P<0.0017) for patients with door-to-needle times ≤60 minutes compared with patients with door-to-needle times >60 minutes.
Fewer than one-third of patients treated with intravenous tPA had door-to-needle times ≤60 minutes, with only modest improvement over the past 6.5 years. These findings support the need for a targeted initiative to improve the timeliness of reperfusion in acute ischemic stroke.
静脉注射组织型纤溶酶原激活物（tPA）治疗急性缺血性脑卒中的获益与时间相关，指南建议发病至开始治疗（门到针）的时间应≤60 分钟。
对 2003 年 4 月 1 日至 2009 年 9 月 30 日期间参与“Get With the Guidelines-Stroke”计划的 1082 家医院接受 tPA 治疗且症状发作后 3 小时内的急性缺血性脑卒中患者的数据进行研究，以确定≤60 分钟门到针时间的患者的频率、患者和医院特征以及时间趋势。在 25504 例接受 tPA 治疗的缺血性脑卒中患者中，仅有 6790 例（26.6%）的门到针时间≤60 分钟。与门到针时间≤60 分钟最密切相关的患者因素是年龄较小、男性、白种人或既往无卒中。与≤60 分钟门到针时间相关的医院因素包括 tPA 治疗的脑卒中患者的年治疗量更大。门到针时间≤60 分钟的患者比例因医院而异（0%至 79.2%），且从 2003 年的 19.5%增加至 2009 年的 29.1%（P<0.0001）。尽管卒中严重程度相似，但门到针时间≤60 分钟的患者院内死亡率较低（校正比值比，0.78；95%置信区间，0.69 至 0.90；P<0.0003），症状性颅内出血发生率较低（4.7%比 5.6%；P<0.0017）。
接受静脉 tPA 治疗的患者中，≤60 分钟的门到针时间患者不足三分之一，在过去的 6.5 年中仅有适度改善。这些发现支持需要采取有针对性的举措来提高急性缺血性脑卒中的再灌注及时性。
