Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Ann Clin Transl Neurol. 2021 Aug;8(8):1592-1600. doi: 10.1002/acn3.51400. Epub 2021 Jul 11.
The American Heart Association recently raised the bar on the timely treatment of acute ischemic stroke (AIS) with intravenous alteplase. Our study looks at the effectiveness of this new standard, by examining the effect of varying door-to-needle times of alteplase initiation on the clinical, quality of care, and efficiency of care outcomes.
This retrospective case-control study examined 752 AIS patients treated with intravenous alteplase in a large academic health system during 2015-2018, and compared their outcomes after treatment within 30, 45, and 60 min of arrival. The outcomes compared were: (1) clinical - discharge and 90-day modified Rankin Scale (mRS), and post-intravenous alteplase (24-h) NIH Stroke Scale (NIHSS); (2) quality of care - inpatient mortality, 30-day readmission, discharge to home, and disability at discharge; (3) efficiency of care - length of stay (LOS) and index stroke hospitalization costs. Adjusted logistic and linear regression analyses were used to estimate the effects, after controlling for baseline characteristics.
Based on the adjusted regression analyses, treatment within 30 min of arrival was associated with better post-treatment mRS and NIHSS scores, and the clinical benefits were reduced when the windows were expanded to within 45 or 60 min. An important finding of the study was that treatment within 30 min of arrival significantly reduced the average LOS.
Early intravenous alteplase treatment significantly improved clinical and efficiency of care outcomes. This study provides evidence that meeting the new AHA Target Stroke recommendations will help hospitals improve patient clinical outcomes and reduce LOS, thereby improving the efficiency of care standards.
美国心脏协会最近提高了急性缺血性脑卒中（AIS）静脉注射阿替普酶及时治疗的标准。我们的研究通过考察阿替普酶起始的不同门到针时间对临床、护理质量和护理效率结果的影响，来评估这一新标准的有效性。
本回顾性病例对照研究纳入了 2015 年至 2018 年在一个大型学术医疗系统中接受静脉注射阿替普酶治疗的 752 例 AIS 患者，并比较了他们在到达后 30、45 和 60 分钟内治疗后的结局。比较的结局包括：（1）临床结局——出院时和 90 天改良 Rankin 量表（mRS）评分，以及静脉注射阿替普酶后 24 小时的国立卫生研究院卒中量表（NIHSS）评分；（2）护理质量结局——住院期间死亡率、30 天再入院率、出院回家率和出院时的残疾程度；（3）护理效率结局——住院时间（LOS）和指数卒中住院费用。在控制基线特征后，采用调整后的逻辑回归和线性回归分析来估计这些影响。
基于调整后的回归分析，到达后 30 分钟内治疗与治疗后 mRS 和 NIHSS 评分的改善相关，而当时间窗扩大到 45 分钟或 60 分钟时，临床获益减少。研究的一个重要发现是，到达后 30 分钟内治疗显著降低了平均 LOS。
早期静脉注射阿替普酶治疗显著改善了临床和护理效率结局。本研究提供的证据表明，满足新的美国心脏协会靶卒中建议将有助于医院改善患者的临床结局和降低 LOS，从而提高护理标准的效率。
