Department of Neurology, Institute of Epidemiology and Social Medicine, University of Münster, Domagkstrasse 3, Münster, Germany.
Stroke. 2011 Oct;42(10):2838-43. doi: 10.1161/STROKEAHA.111.616565. Epub 2011 Aug 18.
The European Cooperative Acute Stroke Study (ECASS) III extended the thrombolysis time window for patients with stroke from 3 to 4.5 hours after symptom onset. We investigated the effect of the extended thrombolysis time window on the proportion of recombinant tissue-type plasminogen activator-treated stroke patients and on the time of treatment initiation after hospital arrival.
The present study was based on a prospective database of 93 hospitals of the Stroke Register of Northwestern Germany, which included 91 805 patients with ischemic stroke admitted between January 2007 and December 2009. Main outcome measures were the use of recombinant tissue-type plasminogen activator among patients with stroke and the door-to-needle time before and after the publication of ECASS III in September 2008 and subsequent changes of the German guidelines in May 2009.
Overall, 9262 patients (10.1%) were treated with recombinant tissue-type plasminogen activator. The proportion of thrombolyzed patients increased from 8.6% in 2007 to 11.7% in 2009. This increase was pronounced for patients admitted between 3 and 6 hours after symptom onset after the third quarter of 2008 (OR, 1.88; 95% CI, 1.24 to 2.85) and after the second and third quarters of 2009 (OR, 2.50; 95% CI, 1.69 to 3.69 and OR, 3.02; 95% CI, 2.07 to 4.41) compared with the first half year 2007. The proportion of patients with stroke with a door-to-needle time<60 minutes increased after publication of ECASS III (OR, 1.49; 95% CI, 1.37 to 1.63).
Results of ECASS III were rapidly implemented in routine stroke care. Concerns of a delay in recombinant tissue-type plasminogen activator treatment initiation after the extension of the thrombolysis time window were not confirmed.
欧洲急性卒中协作研究（ECASS）III 将卒中患者溶栓时间窗从症状发作后 3 小时延长至 4.5 小时。本研究旨在调查延长溶栓时间窗对接受重组组织型纤溶酶原激活剂治疗的卒中患者比例以及从入院到开始治疗时间的影响。
本研究基于北德卒中登记处的前瞻性数据库，该数据库纳入了 2007 年 1 月至 2009 年 12 月期间收治的 91805 例缺血性卒中患者。主要结局指标为卒中患者使用重组组织型纤溶酶原激活剂的情况，以及 2008 年 9 月 ECASS III 发表前后以及 2009 年 5 月德国指南更新后的门到针时间。
总体而言，9262 例（10.1%）患者接受了重组组织型纤溶酶原激活剂治疗。溶栓患者比例从 2007 年的 8.6%增加至 2009 年的 11.7%。这种增加在症状发作后 3 至 6 小时内入院的患者中更为明显，2008 年第三季度后（OR，1.88；95%CI，1.24 至 2.85）以及 2009 年第二和第三季度后（OR，2.50；95%CI，1.69 至 3.69 和 OR，3.02；95%CI，2.07 至 4.41），与 2007 年上半年相比，这一比例明显增加。ECASS III 发表后，门到针时间<60 分钟的卒中患者比例增加（OR，1.49；95%CI，1.37 至 1.63）。
ECASS III 的结果迅速应用于常规卒中治疗中。溶栓时间窗延长后，人们对重组组织型纤溶酶原激活剂治疗开始延迟的担忧并未得到证实。
