Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes

Background-The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time dependent, and guidelines recommend an arrival to treatment initiation (door-to-needle) time of <= 60 minutes. Methods and Results-Data from acute ischemic stroke patients treated with tPA within 3 hours of symptom onset in 1082 hospitals participating in the Get With the Guidelines-Stroke Program from April 1, 2003, to September 30, 2009 were studied to determine frequency, patient and hospital characteristics, and temporal trends in patients treated with door-to-needle times <= 60 minutes. Among 25 504 ischemic stroke patients treated with tPA, door-to-needle time was <= 60 minutes in only 6790 (26.6%). Patient factors most strongly associated with door-to-needle time <= 60 minutes were younger age, male gender, white race, or no prior stroke. Hospital factors associated with <= 60 minute door-to-needle time included greater annual volumes of tPA-treated stroke patients. The proportion of patients with door-to-needle times <= 60 minutes varied widely by hospital (0% to 79.2%) and increased from 19.5% in 2003 to 29.1% in 2009 (P < 0.0001). Despite similar stroke severity, in-hospital mortality was lower (adjusted odds ratio, 0.78; 95% confidence interval, 0.69 to 0.90; P < 0.0003) and symptomatic intracranial hemorrhage was less frequent (4.7% versus 5.6%; P < 0.0017) for patients with door-to-needle times <= 60 minutes compared with patients with door-to-needle times <= 60 minutes. Conclusions-Fewer than one-third of patients treated with intravenous tPA had door-to-needle times <= 60 minutes, with only modest improvement over the past 6.5 years. These findings support the need for a targeted initiative to improve the timeliness of reperfusion in acute ischemic stroke. (Circulation. 2011; 123: 750-758.)