Importance Earlier administration of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke is associated with reduced mortality by the time of hospital discharge and better functional outcomes at 3 months. However, it remains unclear whether shorter door-to-needle times translate into better long-term outcomes. Objective To examine whether shorter door-to-needle times with intravenous tPA for acute ischemic stroke are associated with improved long-term outcomes. Design, Setting, and Participants This retrospective cohort study included Medicare beneficiaries aged 65 years or older who were treated for acute ischemic stroke with intravenous tPA within 4.5 hours from the time they were last known to be well at Get With The Guidelines-Stroke participating hospitals between January 1, 2006, and December 31, 2016, with 1-year follow-up through December 31, 2017. Exposures Door-to-needle times for intravenous tPA. Main Outcomes and Measures The primary outcomes were 1-year all-cause mortality, all-cause readmission, and the composite of all-cause mortality or readmission. Results Among the 61 426 patients treated with tPA within 4.5 hours, the median age was 80 years and 43.5% were male. The median door-to-needle time was 65 minutes (interquartile range, 49-88 minutes). The 48 666 patients (79.2%) who were treated with tPA and had door-to-needle times of longer than 45 minutes, compared with those treated within 45 minutes, had significantly higher all-cause mortality (35.0% vs 30.8%, respectively; adjusted HR, 1.13 [95% CI, 1.09-1.18]), higher all-cause readmission (40.8% vs 38.4%; adjusted HR, 1.08 [95% CI, 1.05-1.12]), and higher all-cause mortality or readmission (56.0% vs 52.1%; adjusted HR, 1.09 [95% CI, 1.06-1.12]). The 34 367 patients (55.9%) who were treated with tPA and had door-to-needle times of longer than 60 minutes, compared with those treated within 60 minutes, had significantly higher all-cause mortality (35.8% vs 32.1%, respectively; adjusted hazard ratio [HR], 1.11 [95% CI, 1.07-1.14]), higher all-cause readmission (41.3% vs 39.1%; adjusted HR, 1.07 [95% CI, 1.04-1.10]), and higher all-cause mortality or readmission (56.8% vs 53.1%; adjusted HR, 1.08 [95% CI, 1.05-1.10]). Every 15-minute increase in door-to-needle times was significantly associated with higher all-cause mortality (adjusted HR, 1.04 [95% CI, 1.02-1.05]) within 90 minutes after hospital arrival, but not after 90 minutes (adjusted HR, 1.01 [95% CI, 0.99-1.03]), higher all-cause readmission (adjusted HR, 1.02; 95% CI, 1.01-1.03), and higher all-cause mortality or readmission (adjusted HR, 1.02 [95% CI, 1.01-1.03]). Conclusions and Relevance Among patients aged 65 years or older with acute ischemic stroke who were treated with tissue plasminogen activator, shorter door-to-needle times were associated with lower all-cause mortality and lower all-cause readmission at 1 year. These findings support efforts to shorten time to thrombolytic therapy.

中文翻译：

---

急性缺血性卒中患者溶栓门到针时间与 1 年死亡率和再入院率之间的关系

重要性 急性缺血性卒中早期静脉注射组织纤溶酶原激活剂 (tPA) 与出院时死亡率降低和 3 个月时更好的功能结局相关。然而，尚不清楚更短的上门到针时间是否会转化为更好的长期结果。目的 旨在检查急性缺血性卒中静脉注射 tPA 的更短的进针时间是否与改善的长期结果相关。设计、设置和参与者 这项回顾性队列研究包括 65 岁或以上的 Medicare 受益人，他们在最后一次被告知在 Get With The Guidelines-Stroke 参与医院康复后 4.5 小时内接受了静脉内 tPA 的急性缺血性卒中治疗2006年1月1日至2016年12月31日期间，随访 1 年至 2017 年 12 月 31 日。 静脉注射 tPA 的门到针时间。主要结果和措施 主要结果是 1 年全因死亡率、全因再入院和全因死亡率或再入院的复合。结果在4.5小时内接受tPA治疗的61 426例患者中，中位年龄为80岁，43.5%为男性。中位进针时间为 65 分钟（四分位距，49-88 分钟）。与 45 分钟内接受治疗的患者相比，接受 tPA 治疗且进针时间超过 45 分钟的 48 666 名患者 (79.2%) 的全因死亡率显着更高（分别为 35.0% 和 30.8%） ；调整后的 HR，1.13 [95% CI，1.09-1.18]），更高的全因再入院率（40.8% 对 38.4%；调整后的 HR，1.08 [95% CI，1.05-1.12]），以及更高的全因死亡率或再入院率（56.0% 与 52.1%；调整后的 HR，1.09 [95% CI，1.06-1.12]）。与 60 分钟内接受治疗的患者相比，接受 tPA 治疗且进针时间超过 60 分钟的 34 367 名患者 (55.9%) 的全因死亡率显着更高（分别为 35.8% 和 32.1%） ；调整后的风险比 [HR]，1.11 [95% CI，1.07-1.14]），更高的全因再入院率（41.3% 对 39.1%；调整后的 HR，1.07 [95% CI，1.04-1.10]），并且更高- 导致死亡或再入院（56.8% 对 53.1%；调整后的 HR，1.08 [95% CI，1.05-1.10]）。入院后 90 分钟内，上门至针刺时间每增加 15 分钟，与更高的全因死亡率（调整后的 HR，1.04 [95% CI，1.02-1.05]）显着相关，但在 90 分钟后（调整后的 HR 为HR，1.01 [95% CI，0.99-1.03]），更高的全因再入院率（调整后的 HR，1.02；95% CI，1.01-1.03），以及更高的全因死亡率或再入院率（调整后的 HR，1.02 [95% CI，1.01-1.03]）。结论和相关性 在接受组织纤溶酶原激活剂治疗的 65 岁或以上急性缺血性卒中患者中，较短的入院时间与较低的全因死亡率和较低的 1 年全因再入院率相关。这些发现支持缩短溶栓治疗时间的努力。更短的进针时间与更低的全因死亡率和更低的 1 年全因再入院率相关。这些发现支持缩短溶栓治疗时间的努力。更短的进针时间与更低的全因死亡率和更低的 1 年全因再入院率相关。这些发现支持缩短溶栓治疗时间的努力。