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 purpose We 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.Methods We analysed data from the Chi...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e055055.full |
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| author | Yong-Jun Wang Xin Yang Qi Zhou Hao Li Xia Meng Yong Jiang Li-Ping Liu Yi-long Wang Hong-Qiu Gu Zi-Xiao Li Xing-Quan Zhao Chun-Juan Wang Chelsea Liu Hai-yan Wang Ying-Yu Jiang |
| author_facet | Yong-Jun Wang Xin Yang Qi Zhou Hao Li Xia Meng Yong Jiang Li-Ping Liu Yi-long Wang Hong-Qiu Gu Zi-Xiao Li Xing-Quan Zhao Chun-Juan Wang Chelsea Liu Hai-yan Wang Ying-Yu Jiang |
| author_sort | Yong-Jun Wang |
| collection | DOAJ |
| description | Background and purpose We 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.Methods We 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).Results Of 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.Conclusion Young 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. |
| format | Article |
| id | doaj-art-e367466c29b14250822617c4d15332f3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e367466c29b14250822617c4d15332f32025-01-24T16:45:15ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-055055Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in ChinaYong-Jun Wang0Xin Yang1Qi Zhou2Hao Li3Xia Meng4Yong Jiang5Li-Ping Liu6Yi-long Wang7Hong-Qiu Gu8Zi-Xiao Li9Xing-Quan Zhao10Chun-Juan Wang11Chelsea Liu12Hai-yan Wang13Ying-Yu Jiang142 China National Clinical Research centre for Neurological Diseases, Beijing, China1 School of Nursing, Jinan University, Guangzhou, Guangdong, ChinaNursing Department, Hangzhou Normal University, Hangzhou, Zhejiang, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing, China2 China National Clinical Research centre for Neurological Diseases, Beijing, China2 China National Clinical Research centre for Neurological Diseases, Beijing, China1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China8 Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USADepartment of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, ChinaChina National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaBackground and purpose We 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.Methods We 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).Results Of 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.Conclusion Young 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.https://bmjopen.bmj.com/content/12/6/e055055.full |
| spellingShingle | Yong-Jun Wang Xin Yang Qi Zhou Hao Li Xia Meng Yong Jiang Li-Ping Liu Yi-long Wang Hong-Qiu Gu Zi-Xiao Li Xing-Quan Zhao Chun-Juan Wang Chelsea Liu Hai-yan Wang Ying-Yu Jiang Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China BMJ Open |
| title | Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China |
| title_full | Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China |
| title_fullStr | Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China |
| title_full_unstemmed | Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China |
| title_short | Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China |
| title_sort | thrombolysis time to treatment and in hospital outcomes among young adults with ischaemic stroke in china findings from a nationwide registry study in china |
| url | https://bmjopen.bmj.com/content/12/6/e055055.full |
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