title: Ultraearly thrombolysis in acute ischemic stroke is associated with better outcome and lower mortality.
abstract: OBJECTIVE
  Pooled analysis of major placebo-controlled trials suggests that the earlier thrombolysis is given after ischemic stroke, the better the outcome. We report a single-center assessment of the effect of ultraearly thrombolysis on the outcome of our patients.
  
  
  METHODS
  Between January 2003, and December 2008, a total of 878 patients with ischemic stroke received thrombolysis within 4.5 hours from the symptom onset at the Helsinki University Central Hospital. Using univariate methods and multivariable logistic regression, we assessed the association between onset-to-treatment time (OTT) and favorable 3-month outcome (modified Rankin Scale 0 to 2).
  
  
  RESULTS
  Median age was 70.5 years, median OTT 115 minutes, and median National Institutes of Health Stroke Scale (NIHSS) on admission 9. After adjustment for baseline stroke severity, more patients with OTT <70 minutes had a favorable outcome than those with OTT > or = 70 minutes. Specifically, OR of 5.15 (1.50 to 27.5) was for the patients with NIHSS 7 to 12, and 2.74 (1.26 to 5.90) for those with NIHSS > or = 13. Of the patients with OTT < or = 90 minutes, those with NIHSS 7 to 12 had an OR of 1.72 (1.00 to 2.96) for a favorable outcome, and those with NIHSS > or = 13 had lower mortality than the ones with OTT >90 minutes (16.4% versus 29.5%; P=0.01). Multivariable model showed an association of better outcome with lower baseline glucose level, younger age, lower baseline NIHSS, and OTT <70 minutes.
  
  
  CONCLUSIONS
  Ultraearly thrombolysis was associated with better outcome of our patients with stroke with moderate or severe symptoms. The earlier the treatment was given, the higher the likelihood of favorable outcome.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. daniel.strbian@hus.fi
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Lauri
authors.initials: L
authors.lastname: Soinne
authors.forename: Tiina
authors.initials: T
authors.lastname: Sairanen
authors.forename: Olli
authors.initials: O
authors.lastname: Häppölä
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010919:Placebos; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010919:Placebos