Thrombolytic therapy for acute stroke in Austria: data from the Safe Implementation of Thrombolysis in Stroke (SITS) register.
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.
Topakian
R
R
Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz.
Brainin
M
M
Department of Neurology, Landesklinikum Donauregion Tulln, Tulln.|Centre for Clinical Neurosciences, Danube University Krems, Krems.
Eckhardt
R
R
Department of Neurology, Landesklinikum Donauregion Tulln, Tulln.|Centre for Clinical Neurosciences, Danube University Krems, Krems.
Kiechl
S
S
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Ahmed
N
N
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Ferrari
J
J
Department of Neurology, Hospital Barmherzige Brueder Vienna, Vienna.
Iglseder
B
B
Department of Neurology, Paracelsus Medical University, Salzburg.
Wahlgren
N G
NG
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Lang
W
W
Department of Neurology, Hospital Barmherzige Brueder Vienna, Vienna.
Fazekas
F
F
Department of Neurology, University Hospital Graz, Graz, Austria.
Willeit
J
J
Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Aichner
F T
FT
Department of Neurology, Academic Teaching Hospital Wagner-Jauregg, Linz.
D000368:Aged; D001317:Austria; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator