Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is
Safer and Improves Outcome in the Czech Republic: Nationwide
Study 2004 to 2019

J 2022

Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019

MIKULÍK, Robert, Michal BAR, Silvie BELASKOVA, David CERNIK, Jan FIKSA et. al.

Basic information

Original name

Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019

Authors

MIKULÍK, Robert (203 Czech Republic, belonging to the institution), Michal BAR (203 Czech Republic), Silvie BELASKOVA (203 Czech Republic), David CERNIK (203 Czech Republic), Jan FIKSA (203 Czech Republic), Roman HERZIG (203 Czech Republic), René JURA (203 Czech Republic, belonging to the institution), Lubomir JURAK (203 Czech Republic), Lukas KLECKA (203 Czech Republic), Jiri NEUMANN (203 Czech Republic), Svatopluk OSTRY (203 Czech Republic), Daniel SANAK (203 Czech Republic), Petr SEVCIK (203 Czech Republic), Ondrej SKODA (203 Czech Republic), Martin SRAMEK (203 Czech Republic), Ales TOMEK (203 Czech Republic) and Daniel VACLAVIK (203 Czech Republic)

Edition

Journal of the American Heart Association, Hoboken, Wiley-Blackwell, 2022, 2047-9980

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 5.400

RIV identification code

RIV/00216224:14110/22:00126028

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1161/JAHA.121.023524

UT WoS

000796637400009

Keywords in English

acute ischemic stroke; door-to-needle time; intravenous thrombolysis; stroke logistics

Abstract

V originále

Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70 +/- 13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5-14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT <= 20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12-1.51), 1.33 (95% CI, 1.15-1.54), and 1.15 (95% CI, 1.02-1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45-0.71), 0.76 (95% CI, 0.61-0.94), 0.83 (95% CI, 0.70-0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.

Links

LM2018128, research and development project

Name: Český národní uzel Evropské sítě infrastruktur klinického výzkumu (Acronym: CZECRIN)

Investor: Ministry of Education, Youth and Sports of the CR

Citovat

MIKULÍK, Robert, Michal BAR, Silvie BELASKOVA, David CERNIK, Jan FIKSA, Roman HERZIG, René JURA, Lubomir JURAK, Lukas KLECKA, Jiri NEUMANN, Svatopluk OSTRY, Daniel SANAK, Petr SEVCIK, Ondrej SKODA, Martin SRAMEK, Ales TOMEK and Daniel VACLAVIK. Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019. Journal of the American Heart Association. Hoboken: Wiley-Blackwell, 2022, vol. 11, No 10, p. 1-13. ISSN 2047-9980. Available from: https://dx.doi.org/10.1161/JAHA.121.023524.

@article{1860560,
   author = {Mikulík, Robert and Bar, Michal and Belaskova, Silvie and Cernik, David and Fiksa, Jan and Herzig, Roman and Jura, René and Jurak, Lubomir and Klecka, Lukas and Neumann, Jiri and Ostry, Svatopluk and Sanak, Daniel and Sevcik, Petr and Skoda, Ondrej and Sramek, Martin and Tomek, Ales and Vaclavik, Daniel},
   article_location = {Hoboken},
   article_number = {10},
   doi = {http://dx.doi.org/10.1161/JAHA.121.023524},
   keywords = {acute ischemic stroke; door-to-needle time; intravenous thrombolysis; stroke logistics},
   language = {eng},
   issn = {2047-9980},
   journal = {Journal of the American Heart Association},
   title = {Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019},
   url = {https://www.ahajournals.org/doi/full/10.1161/JAHA.121.023524?af=R},
   volume = {11},
   year = {2022}
}

TY  - JOUR
ID  - 1860560
AU  - Mikulík, Robert - Bar, Michal - Belaskova, Silvie - Cernik, David - Fiksa, Jan - Herzig, Roman - Jura, René - Jurak, Lubomir - Klecka, Lukas - Neumann, Jiri - Ostry, Svatopluk - Sanak, Daniel - Sevcik, Petr - Skoda, Ondrej - Sramek, Martin - Tomek, Ales - Vaclavik, Daniel
PY  - 2022
TI  - Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019
JF  - Journal of the American Heart Association
VL  - 11
IS  - 10
SP  - 1-13
EP  - 1-13
PB  - Wiley-Blackwell
SN  - 20479980
KW  - acute ischemic stroke
KW  - door-to-needle time
KW  - intravenous thrombolysis
KW  - stroke logistics
UR  - https://www.ahajournals.org/doi/full/10.1161/JAHA.121.023524?af=R
N2  - Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70 +/- 13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5-14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT <= 20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12-1.51), 1.33 (95% CI, 1.15-1.54), and 1.15 (95% CI, 1.02-1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45-0.71), 0.76 (95% CI, 0.61-0.94), 0.83 (95% CI, 0.70-0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.
ER  -

MIKULÍK, Robert, Michal BAR, Silvie BELASKOVA, David CERNIK, Jan FIKSA, Roman HERZIG, René JURA, Lubomir JURAK, Lukas KLECKA, Jiri NEUMANN, Svatopluk OSTRY, Daniel SANAK, Petr SEVCIK, Ondrej SKODA, Martin SRAMEK, Ales TOMEK and Daniel VACLAVIK. Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019. \textit{Journal of the American Heart Association}. Hoboken: Wiley-Blackwell, 2022, vol.~11, No~10, p.~1-13. ISSN~2047-9980. Available from: https://dx.doi.org/10.1161/JAHA.121.023524.

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