• Cerebrovascular Disease
• Neurology Clinical Trials

• Cerebrovascular Disease
• Neurology Clinical Trials
• Neurology

The American Heart Association (AHA)/American Stroke Association (ASA) guidelines recommend a door-to-needle (DTN) time of ≤60 minutes for reperfusion therapy for acute ischemic stroke patients [Jauch EC et al. Stroke 2013]. The rapid treatment is important for improving stroke outcome, but many studies have concluded that this time frame has been met by <30% of intravenous tissue plasminogen activator (t-PA)-treated stroke patients.

Gregg C. Fonarow, MD, University of California Los Angeles, Los Angeles, California, USA, presented the principal results from the Target: Stroke Initiative, a national program organized by the AHA/ASA, which addresses this timing dilemma by increasing the proportion of stroke patients with DTN time frames of <60 minutes. The primary goal of the study was to treat at least 50% of acute ischemic stroke patients at Get With The Guidelines (GWTG)-Stroke participating hospitals and see that they were treated within 60 minutes of their arrival to the hospital [Fonarow GC et al. Stroke 2011]. In performing this assessment, 10 key evidence-based strategies were utilized to meet the goal (Table 1).

This study included various ongoing adjustments as they related to assessing the variables of patients and characteristics. Assessments were made of in-hospital mortality, discharge destination, ambulatory status, and symptomatic intracranial hemorrhage ≤36 hours following t-PA administration. Patient profiles included a balance of men and women, median age 72 years, who were of white, Hispanic, and black origins. Of the stroke patients treated with t-PA (n=71,169) 27,319 were pre-intervention and 43,850 were postintervention patients from 1030 GWTG-Stroke participating hospitals (Figure 1).

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Figure 1.

Selection of Study Population for Target: Stroke

IV=intravenous; OTT=onset to treatment; t-PA= tissue plasminogen activator.

Prior to the study's initiation in 2009, 15.6% of hospitals had DTN rates of ≤60 minutes in ≥50% of t-PA-treated stroke patients. Median time was 74 minutes in Quarter 4 of 2009, immediately prior to the start of the Target: Stroke initiative. The study's DTN goal was subsequently met by 46.7% of the participating hospitals by 2013 (p<0.0001) and by 53.3% of patients by Quarter 3, 2013 (p<0.0001). The program's goal of DTN times of ≤60 minutes was achieved within 4 years as opposed to the originally projected 15 years.

With a target of achieving a more rapid administration of t-PA, there were initial concerns centered on the shorter DTN times as related to rushed overall assessments for acute ischemic stroke patients. The Target: Stroke Initiative research revealed that rapid reperfusion therapy in acute ischemic stroke can be done with process reductions and improved outcomes.

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