Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China

Background and purposeWe aimed to determine whether young adults (<50 years) with acute ischaemic stroke (AIS) are more likely to receive intravenous tissue plasminogen activator (IV tPA) and have shorter time to treatment than older patients with stroke.MethodsWe analysed data from the Chinese S...

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Veröffentlicht in:BMJ open Jg. 12; H. 6; S. e055055
Hauptverfasser: Wang, Hai-Yan, Gu, Hong-Qiu, Zhou, Qi, Jiang, Ying-Yu, Yang, Xin, Wang, Chun-Juan, Zhao, Xing-Quan, Wang, Yi-Long, Liu, Li-Ping, Meng, Xia, Li, Hao, Liu, Chelsea, Li, Zi-Xiao, Wang, Yong-Jun, Jiang, Yong
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London British Medical Journal Publishing Group 01.06.2022
BMJ Publishing Group LTD
BMJ Publishing Group
Schriftenreihe:Original research
Schlagworte:
adult neurology
Emergency medical care
Intravenous therapy
Ischemia
Neurology
Stroke
Thrombolytic drugs
vascular medicine
Young adults
Beijing China
China
ISSN:2044-6055, 2044-6055
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Zusammenfassung:Background and purposeWe aimed to determine whether young adults (<50 years) with acute ischaemic stroke (AIS) are more likely to receive intravenous tissue plasminogen activator (IV tPA) and have shorter time to treatment than older patients with stroke.MethodsWe analysed data from the Chinese Stroke Center Alliance registry for patients with AIS hospitalised between August 2015 and July 2019. Patients were classified into two groups according to age: young adults (<50 years of age) and older adults (≥50 years of age).ResultsOf 793 175 patients with AIS admitted to 1471 hospitals, 9.1% (71 860) were young adults. Compared with older adults, a higher proportion of young adults received IV tPA among patients without contraindicaitons (7.2% vs 6.1%, adjusted OR (aOR) 1.13, 95% CI 1.10 to 1.17) and among patients without contraindications and with onset-to-door time ≤3.5 hours (23.6% vs 19.3%, aOR 1.20, 95% CI 1.15 to 1.24). We did not observe differences in onset-to-needle time (median hours 2.7 hours) or door-to-needle time (DNT) (median minutes 60 min) between young and older adults. The proportion of DNT ≤30 min, DNT ≤45 min and DNT ≤60 min in young and older IV tPA-treated patients were 16.9% vs 18.8%, 30.2% vs 32.8% and 50.2% vs 54.2%, respectively. Compared with older adults, young adults treated with IV tPA had lower odds of in-hospital mortality (0.5% vs 1.3%, aOR 0.54, 95% CI 0.35 to 0.82) and higher odds of independent ambulation at discharge (61.0% vs 53.6%, aOR 1.15, 95% CI 1.08 to 1.22), and the associations may be partly explained by stroke severity measured by the National Institutes of Health Stroke Scale score.ConclusionYoung adults with AIS were more likely to receive IV tPA than older adults, although there was no difference between the two groups in time to treatment. Compared with older adults, young adults may had better in-hospital outcomes.
Bibliographie:Original research
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ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2021-055055