Abstract 102: Adherence to ECASS III 3-4.5 Hour Exclusion Criteria and Association with Outcome in Clinical Practice: Data from Get With The Guidelines (GWTG)-Stroke
Introduction: AHA/ASA guidelines recommend IV tPA treatment 3-4.5 hours from symptom onset according to criteria used in the ECASS III study. However, ECASS III excluded certain patient groups in addition to the standard exclusions for <3 hours in the USA: age >80, history of stroke and diabetes, oral anticoagulant treatment, and NIHSS>25. We investigated adherence to these additional exclusion criteria for patients treated 3-4.5 hours from symptom onset, and their association with outcome.
Methods: We analyzed data from GWTG-Stroke on 32,019 ischemic stroke patients from 1464 hospitals who were treated with IV tPA within 4.5 hr of symptom onset from January 2009 to January 2012, excluding patients transferred from an outside hospital. The percent of patients meeting vs not-meeting each exclusion criterion were compared between treatment time windows. For each criterion, outcomes were compared for patients treated <3 vs. 3-4.5 hr. P-values were based on Pearson Chi-square test.
Results: Overall, 1544/4910 (31.5%) of patients treated with IV tPA in the 3-4.5 hour window had at least one of the additional exclusions. The most common additional exclusion among treated patients was age > 80. With the exception of prior stroke and diabetes, the percent of tPA treated patients with each exclusion criterion was lower at 3-4.5 hr compared with <3 hr (Table 1A). For each of the additional exclusion criteria, there was no difference in sICH or hospital outcome for patients treated <3 vs. 3-4.5 hr (Table 1B).
Conclusions: Patients with ECASS III-specific exclusion criteria for the 3-4.5 hr window are frequently treated with IV tPA in the U.S. The exclusion criteria were not associated with worse outcomes in the 3-4.5 hr window compared to the <3 hr window.
- © 2012 by American Heart Association, Inc.