Tsivgoulis Georgios, Katsanos Aristeidis H, Kadlecová Pavla, Czlonkowska Anna, Kobayashi Adam, Brozman Miroslav, Švigelj Viktor, Csiba Laszlo, Fekete Klara, Kõrv Janika, Demarin Vida, Vilionskis Aleksandras, Jatuzis Dalius, Krespi Yakup, Liantinioti Chrissoula, Giannopoulos Sotirios, Mikulik Robert
Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece.
International Clinical Research Center and Neurology Department, St. Anne's Hospital, Brno, Czech Republic.
J Neurol. 2017 May;264(5):912-920. doi: 10.1007/s00415-017-8461-8. Epub 2017 Mar 18.
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.
由于关于急性缺血性卒中（AIS）患者在症状发作后60分钟内（“黄金时间”）接受静脉溶栓治疗（IVT）的预后数据稀缺，我们试图通过分析SITS-EAST注册研究中的倾向评分匹配数据，比较在“黄金时间”内[GH(+)]和“黄金时间”外[GH(-)]接受治疗的AIS患者的预后。2小时和24小时时的临床恢复（CR）分别定义为美国国立卫生研究院卒中量表（NIHSS）评分降低≥10分或2小时和24小时时NIHSS总分≤3分。2小时时NIHSS评分相对降低≥40%被认为可预测完全再通（CREC）。有症状颅内出血（sICH）根据SITS-MOST标准定义。良好功能预后（FFO）定义为3个月时改良Rankin量表（mRS）评分为0-1分。在19077例接受IVT治疗的AIS患者中，71例GH(+)患者与6882例GH(-)患者匹配，基线特征无差异（p>0.1）。GH(+)组在2小时（31.0%对12.4%；p<0.001）和24小时（41%对27%；p=0.010）时CR率更高，2小时时CREC率更高（39%对21%；p<0.001），3个月时FFO率更高（46.5%对34.0%；p=0.028）。两组间sICH率和3个月死亡率无差异（p>0.2）。在调整潜在混杂因素的多变量逻辑回归模型中，GH(+)与2小时CR（比值比：5.34；95%置信区间2.53-11.03）、CREC（比值比：2.38；95%置信区间1.38-4.09）、24小时CR（比值比：1.88；95%置信区间1.08-3.26）和3个月FFO（比值比：2.02；95%置信区间1.15-3.54）相关。总之，在黄金时间内接受IVT治疗的AIS患者早期神经功能恢复、CREC、3个月FFO和功能改善的几率似乎显著更高。
