title: Using recombinant tissue plasminogen activator to treat acute ischemic stroke in China: analysis of the results from the Chinese National Stroke Registry (CNSR).
abstract: OBJECTIVE
  Little is known about intravenous recombinant tissue plasminogen activator (rtPA) use in China. By accessing the Chinese National Stroke Registry (CNSR), the rate of intravenous rtPA use was reviewed. We specifically examined the issues of prehospital and in-emergency department delay and compared them with the published data from developed countries.
  
  
  METHODS
  Funded by Chinese government, CNSR is the only nationwide stroke registry that includes 132 urban hospitals. All patients eligible for intravenous rtPA were included for analysis. We then compared the onset-to-needle time and door-to-needle time in the emergency department in China with those in developed countries.
  
  
  RESULTS
  From September 2007 to August 2008, 14,702 patients with ischemic stroke were entered into CNSR. Among 11,675 patients with known time of stroke onset, 2514 (21.5%) presented to the emergency department within 3 hours, 1469 (12.6%) were eligible for thrombolytic treatment, and 284 (2.4%) were finally treated, 181 (1.6%) of them with intravenous rtPA. The median onset-to-needle time was 180 (interquartile range, 150 to 228) minutes; the median door-to-needle time was 116 (interquartile range, 70 to 150) minutes; the median imaging-to-needle time was 90 (interquartile range, 60 to 129) minutes. Patients who were younger, presented to the emergency department quicker, with higher National Institutes of Health Stroke Scale scores, having higher income, and better education had a better chance of receiving intravenous rtPA.
  
  
  CONCLUSIONS
  Approximately 1 in 5 patients with stroke presenting within 3 hours received thrombolytic therapy. The onset-to-needle time, door-to-needle time, and especially imaging-to-needle time were significantly longer than those in developed countries. Reducing prehospital and in-emergency department response time would help increase intravenous rtPA use in China.
authors.affiliation: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Chongwen District, Beijing, China. yilong528@gmail.com
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Liao
authors.forename: Xingquan
authors.initials: X
authors.lastname: Zhao
authors.forename: David Z
authors.initials: DZ
authors.lastname: Wang
authors.forename: Chunxue
authors.initials: C
authors.lastname: Wang
authors.forename: Mai N
authors.initials: MN
authors.lastname: Nguyen-Huynh
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.forename: Xianwei
authors.initials: X
authors.lastname: Wang
authors.forename: Gaifen
authors.initials: G
authors.lastname: Liu
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D002681:China; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator