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Thrombolytic therapy for acute stroke in Austria: data from the Safe Implementation of Thrombolysis in Stroke (SITS) register
Author(s) -
Topakian R.,
Brainin M.,
Eckhardt R.,
Kiechl S.,
Ahmed N.,
Ferrari J.,
Iglseder B.,
Wahlgren N. G.,
Lang W.,
Fazekas F.,
Willeit J.,
Aichner F. T.
Publication year - 2011
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2010.03141.x
Subject(s) - medicine , interquartile range , thrombolysis , hazard ratio , stroke (engine) , cohort , odds ratio , confidence interval , pediatrics , myocardial infarction , mechanical engineering , engineering
Background: We aimed at determining the safety and efficacy of IV alteplase in Austrian versus non‐Austrian centres as documented in the Internet‐based registers Safe Implementation of Thrombolysis for Stroke – MOnitoring STudy (SITS‐MOST) and – International Stroke Thrombolysis Register (SITS‐ISTR). Methods: We analysed patient data entered in the registers SITS‐MOST and SITS‐ISTR in the period December 2002 to 15 November 2007. Results: Compared to the non‐Austrian cohort ( n = 15153), the Austrian cohort ( n = 896) was slightly older [median, interquartile range (IQR): 70, 60–77 years vs. 69, 60–76 years, P = 0.05] and included more women (44.6% vs. 41.0%, P = 0.03). Austrian patients had a significantly shorter stroke onset‐to‐treatment time (OTT; median, IQR: 135, 105–160 min vs. 145, 115–170 min, P < 0.0005). Symptomatic intracerebral haemorrhages were observed in 1.6% of Austrian and 1.7% of non‐Austrian patients ( P = 0.82). At 3 months, 50.8% of Austrian and 53.0% of non‐Austrian patients were independent ( P = 0.23), but death was less frequent in Austrian patients (12.1% vs. 14.9%, P = 0.03). Multivariate analyses adjusted for demographic and baseline characteristics confirmed lower mortality at 3 months in the Austrian cohort (odds ratio 0.81, 95% confidence intervals 0.71–0.92, P = 0.001). Longer OTT was associated with increased mortality at 3 months, with a hazard ratio of 1.02 (95% CI 1.01–1.03; P = 0.005) for each 10‐min increase in OTT. Conclusions: The implementation of intravenous alteplase for acute stroke has been safe and efficacious in Austrian centres. OTT and mortality were significantly lower in Austrian patients compared to non‐Austrian SITS centres.