Abstract 139: Acute Stroke Reperfusion Therapy Trends in the Expanded Treatment Window Era
BACKGROUND: The American Heart Association/American Stroke Association (AHA/ASA) recommended an expansion of the time window for acute ischemic stroke (AIS) reperfusion with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) from 3 to 4.5 hours after symptom onset. We examined rates of IV and intra-arterial (IA) reperfusion before and after the recommendations to track guideline adoption in community practice.
METHODS: Patients with AIS in the Paul Coverdell National Acute Stroke Registry spanning years 2007 to 2012 were identified. Trends in rates of IV rt-PA versus IA therapy were examined. Outcomes studied included symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, ability to ambulate at discharge, and discharge destination.
RESULTS: From 2007 to 2012, there were 182,235 AIS patients (median age 72 years, 51.5% women) in the database. AIS patients receiving IV rt-PA increased significantly from 3.7% in 2007 to 5.1% in 2012 in the ≤ 3 hour time window and from 0.2% in 2007 to 1.3% in 2012 in the 3-4.5 hour time window (p<0.001 for both). There was also a significant increase in rate of IA therapy between 2007 and 2012 from 0.5% to 1.9% (p<0.001). There was a significant decrease in the rate of sICH among patients who received any reperfusion therapy between 2007 and 2012 (p=0.003).
CONCLUSION: There was increased utilization of IV rt-PA in the 3-4.5 hour time window from 2007 to 2012, which is likely from guideline recommendations from the AHA/ASA. This increase was associated with an increase in IA treatment rate along with a decrease in overall sICH rates for patients receiving any reperfusion therapy.
Author Disclosures: G. Asaithambi: None. X. Tong: None. M.G. George: None. A.W. Tsai: None. J.M. Peacock: None. R.V. Luepker: None. K. Lakshminarayan: None.
- © 2014 by American Heart Association, Inc.