From the Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.).
Department of Neurology, University of Tennessee Health Science Center, Memphis (G.T.).
Stroke. 2018 Aug;49(8):1996-1999. doi: 10.1161/STROKEAHA.118.021536.
Background and Purpose- Mobile stroke units (MSUs) are known to increase the proportion of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) in the first golden hour (GH) after onset compared with hospital settings (HS). However, because of the low number of AIS patients treated with intravenous thrombolysis within this ultraearly time window in conventional care, characteristics, and outcome of this subgroup of AIS patients have not been compared between MSU and HS. Methods- MSU-GH patients were selected from the Berlin-based MSU (STEMO [Stroke Emergency Mobile]), whereas HS-GH patients were selected from the SITS-EAST (Safe Implementation of Treatments in Stroke-East) registry. The outcome events of interest included the rates of favorable functional outcome (modified Rankin Scale scores of 0 or 1), distribution of the modified Rankin Scale scores, and mortality after 3 months between MSU-GH and HS-GH groups. Results- We identified 117 MSU-GH (38.4% of 305 MSU-treated patients) and 136 HS-GH (0.9% of 15 591 HS-treated patients) eligible patients without prestroke disability. No significant differences were documented in the rates of favorable functional outcome (51.3% versus 46.2%, P=0.487) and mortality (7.7% versus 9.9%, P=0.576) at 3 months, or in the distribution of 3-month modified Rankin Scale scores between the 2 groups ( P=0.196). In multivariable logistic regression analyses, adjusting for potential confounders, MSU treatment was not associated with a significantly different likelihood of favorable functional outcome (odds ratio, 1.84 for MSU patients; 95% CI, 0.86-3.96) or mortality (odds ratio, 0.95; 95% CI, 0.28-3.20) at 3 months. Conclusions- There is no evidence that safety and efficacy of ultraearly intravenous thrombolysis for AIS differs when used in MSUs or in HS.
背景与目的- 与医院环境（HS）相比，移动卒中单元（MSU）可增加发病后首个黄金小时（GH）内接受静脉溶栓（IVT）治疗的急性缺血性卒中（AIS）患者比例。然而，由于在常规治疗中，只有极少数 AIS 患者在这个超早期时间窗内接受静脉溶栓治疗，因此 MSU 与 HS 之间 AIS 患者亚组的特征和结局尚未进行比较。方法- 从柏林的 MSU（STEMO[卒中急诊移动]）中选择 MSU-GH 患者，而从 SITS-EAST（东部卒中治疗安全实施）登记处选择 HS-GH 患者。感兴趣的结局事件包括良好功能结局（改良 Rankin 量表评分 0 或 1）的发生率、改良 Rankin 量表评分分布以及 3 个月时 MSU-GH 与 HS-GH 组之间的死亡率。结果- 我们确定了 117 例 MSU-GH（305 例 MSU 治疗患者中的 38.4%）和 136 例 HS-GH（15591 例 HS 治疗患者中的 0.9%）无卒中前残疾的合格患者。在 3 个月时，良好功能结局（51.3%比 46.2%，P=0.487）和死亡率（7.7%比 9.9%，P=0.576）以及两组 3 个月改良 Rankin 量表评分分布方面，两组间无显著差异（P=0.196）。在多变量逻辑回归分析中，调整潜在混杂因素后，MSU 治疗与良好功能结局（MSU 患者的优势比，1.84；95%CI，0.86-3.96）或死亡率（优势比，0.95；95%CI，0.28-3.20）的可能性均无显著差异。结论- 没有证据表明 AIS 超早期静脉溶栓在 MSU 或 HS 中的安全性和疗效存在差异。
