Temporal Trends in Door-to-needle Time and Patient Characteristics in Patients Treated With Intravenous Thrombolysis: Analysis of the Sits-east Registry

Introduction: Shorter door-to-needle time (DNT) improves treatment efficacy in acute ischemic stroke (AIS) patients. Still, there are groups of patients at increased risk of longer DNT. The goal of our study was to determine temporal trends of DNT. The second goal was to identify if baseline characteristics of patients treated with intravenous thrombolysis changed throughout the years and if such change (e.g. treating older patients) could have affected DNT. Methods: Prospectively collected data from the Safe Implementation of Treatments in Stroke - EAST (12 Central/Eastern European countries) registry between January 2005 and August 2013 were analyzed. Baseline patient characteristics over period 2005-2013 were analyzed descriptively and using ANOVA. DNT and association between DNT and the patient characteristics were analyzed using linear logistic regression. Obtained regression coefficients and descriptive statistics were used to simulate average DNT values in individual years during 2005-2013. Several simulations were performed (e.g. for patients above 80 years). Results: Altogether, all 13401 patients treated with thrombolysis within 4.5 hours of symptom onset between January 2005 and August 2013 with available DNT were analyzed. Mean DNT during 2005-2013 was 74.4min with slightly improving trend over time. We found almost 6-fold increased proportion of octogenarians in 2013 compared to 2005. Patients with lower and higher NIHSS, prestroke mRS 0-2, arriving sooner to hospital, and treated in a center with less experience (<50 pts per year/center) had longer DNT between 2005 and 2013. In patients arriving within 60min to hospital DNT was longest 88min in 2007 and shortest 75min in 2013. Change in baseline characteristics during 2005-2013 can explain only small proportion of DNT (R-squared decreased from 50% in 2005 to 17% in 2013). Conclusions: Although DNT is improving, it remains long especially for some subgroups of patients, e.g. those arriving early to hospital after symptom onset. Every AIS patient should be treated as fast as possible.